Provider Demographics
NPI:1376232777
Name:WEAVER, JOHN (MS, LCMHCA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WEAVER
Suffix:
Gender:M
Credentials:MS, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3914 BATSON DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:27525-7363
Mailing Address - Country:US
Mailing Address - Phone:919-740-3097
Mailing Address - Fax:
Practice Address - Street 1:4814 SIX FORKS RD STE 202
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5246
Practice Address - Country:US
Practice Address - Phone:919-880-4078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18665101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health