Provider Demographics
NPI:1598638017
Name:BECKER, JEFFREY BLAKE JR (MS, MPH, LCSWA)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:BLAKE
Last Name:BECKER
Suffix:JR
Gender:M
Credentials:MS, MPH, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 SUNBRIGHT LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-6436
Mailing Address - Country:US
Mailing Address - Phone:919-500-1336
Mailing Address - Fax:
Practice Address - Street 1:2231 E MILLBROOK RD STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1746
Practice Address - Country:US
Practice Address - Phone:919-307-8165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0201391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical