Provider Demographics
NPI:1396814448
Name:MENEGIO, JASON (MS, LPCS, NCC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:MENEGIO
Suffix:
Gender:M
Credentials:MS, LPCS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 SPRINGS GROVE LN
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-5869
Mailing Address - Country:US
Mailing Address - Phone:631-834-8634
Mailing Address - Fax:877-289-7566
Practice Address - Street 1:440 SPRINGS GROVE LN
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-5869
Practice Address - Country:US
Practice Address - Phone:631-834-8634
Practice Address - Fax:877-289-7566
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCS4967101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102844Medicaid