Provider Demographics
NPI:1407063845
Name:WARREN, JEFFREY M (MS, NCC, NCSC, LPC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:M
Last Name:WARREN
Suffix:
Gender:M
Credentials:MS, NCC, NCSC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3749 BENSON DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7324
Mailing Address - Country:US
Mailing Address - Phone:919-497-7892
Mailing Address - Fax:919-324-3551
Practice Address - Street 1:3749 BENSON DR
Practice Address - Street 2:SUITE A
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7324
Practice Address - Country:US
Practice Address - Phone:919-497-7892
Practice Address - Fax:919-324-3551
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6527101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
11890558OtherCAQH
NC145ACOtherBLUE CROSS BLUE SHIELD
NC6103542Medicaid