Provider Demographics
NPI:1558018382
Name:SPECTOR, JONAH LEE (LCSWA)
Entity Type:Individual
Prefix:
First Name:JONAH
Middle Name:LEE
Last Name:SPECTOR
Suffix:
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3940 PADDINGTON CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-2032
Mailing Address - Country:US
Mailing Address - Phone:480-309-4405
Mailing Address - Fax:
Practice Address - Street 1:808 SALEM WOODS DR STE 104
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3345
Practice Address - Country:US
Practice Address - Phone:480-309-4405
Practice Address - Fax:919-573-0438
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0172231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical