Provider Demographics
NPI:1013203041
Name:WESSON, MICHAEL JASON (MSW, LCSW, LCAS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JASON
Last Name:WESSON
Suffix:
Gender:M
Credentials:MSW, LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5475 LUMLEY RD
Mailing Address - Street 2:STE 101
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-7717
Mailing Address - Country:US
Mailing Address - Phone:919-405-7200
Mailing Address - Fax:919-405-7266
Practice Address - Street 1:5475 LUMLEY RD
Practice Address - Street 2:STE 101
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-7717
Practice Address - Country:US
Practice Address - Phone:919-405-7200
Practice Address - Fax:919-405-7266
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1728101YA0400X
NCC0072731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)