Provider Demographics
NPI:1972249688
Name:BARRETT, JATHAN JR
Entity Type:Individual
Prefix:MR
First Name:JATHAN
Middle Name:
Last Name:BARRETT
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JATHAN
Other - Middle Name:
Other - Last Name:BARRETT
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2967 CASONA WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-5588
Mailing Address - Country:US
Mailing Address - Phone:919-389-9564
Mailing Address - Fax:
Practice Address - Street 1:2967 CASONA WAY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-5588
Practice Address - Country:US
Practice Address - Phone:919-389-9564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0046081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical