Provider Demographics
NPI:1780134932
Name:PACK, JONATHAN (LCMHC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:PACK
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 GROVE ST STE B1
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-3346
Mailing Address - Country:US
Mailing Address - Phone:828-275-0151
Mailing Address - Fax:
Practice Address - Street 1:68 GROVE ST STE B1
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3346
Practice Address - Country:US
Practice Address - Phone:828-275-0151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12502101YP2500X
NC12502101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional