Provider Demographics
NPI:1417030602
Name:JAWORSKI, JANIS J (PHD)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:J
Last Name:JAWORSKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S GREEN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3528
Mailing Address - Country:US
Mailing Address - Phone:828-433-7400
Mailing Address - Fax:828-439-8083
Practice Address - Street 1:401 S GREEN ST
Practice Address - Street 2:SUITE B
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3528
Practice Address - Country:US
Practice Address - Phone:828-433-7400
Practice Address - Fax:828-439-8083
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2385103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC054092000OtherMAGELLAN BEHAVIORAL HEALT
NC110938OtherVALUE OPTIONS
NC4093184OtherAETNA
NC6000422Medicaid
NC03198OtherBLUE CROSS BLUE SHIELD
NC45599OtherCIGNA
NC4093184OtherAETNA