Provider Demographics
NPI:1851461586
Name:SAYRE, JACK M (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:M
Last Name:SAYRE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5003 SOUTHPARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9414
Mailing Address - Country:US
Mailing Address - Phone:919-517-2526
Mailing Address - Fax:919-572-0391
Practice Address - Street 1:5003 SOUTHPARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-9414
Practice Address - Country:US
Practice Address - Phone:919-517-2526
Practice Address - Fax:919-572-0391
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical