Provider Demographics
NPI:1700934262
Name:JAWORSKI, JEFFREY ALLEN (LCAS, LPC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALLEN
Last Name:JAWORSKI
Suffix:
Gender:M
Credentials:LCAS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1639
Mailing Address - Street 2:
Mailing Address - City:MANTEO
Mailing Address - State:NC
Mailing Address - Zip Code:27954-1639
Mailing Address - Country:US
Mailing Address - Phone:910-476-4629
Mailing Address - Fax:252-441-1802
Practice Address - Street 1:110 W WOOD HILL DR
Practice Address - Street 2:
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959-9394
Practice Address - Country:US
Practice Address - Phone:252-441-1802
Practice Address - Fax:252-441-1802
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1059101YA0400X
NC5512101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103427Medicaid