Provider Demographics
NPI:1578759833
Name:CROOK, JONATHAN OLIVER (PHD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:OLIVER
Last Name:CROOK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 SHIPYARD BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6192
Mailing Address - Country:US
Mailing Address - Phone:910-796-7848
Mailing Address - Fax:910-796-7849
Practice Address - Street 1:4000 SHIPYARD BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6192
Practice Address - Country:US
Practice Address - Phone:910-796-7848
Practice Address - Fax:910-796-7849
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6750101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health