Provider Demographics
NPI:1659673184
Name:SEAMON, JEREMY B (MA, LPC, LCAS, CSI)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:B
Last Name:SEAMON
Suffix:
Gender:M
Credentials:MA, LPC, LCAS, CSI
Other - Prefix:
Other - First Name:JEREMY
Other - Middle Name:B
Other - Last Name:SEAMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC, LCAS, CSI
Mailing Address - Street 1:57 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7327
Mailing Address - Country:US
Mailing Address - Phone:910-577-8200
Mailing Address - Fax:910-577-8270
Practice Address - Street 1:57 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7327
Practice Address - Country:US
Practice Address - Phone:910-577-8200
Practice Address - Fax:910-577-8270
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-04
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1726101YA0400X
NCLPC 7682101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6112214Medicaid