Provider Demographics
NPI:1841536281
Name:TRAYLOR, JONATHAN ANDREW (LPC, LCAS, NCC)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:ANDREW
Last Name:TRAYLOR
Suffix:
Gender:M
Credentials:LPC, LCAS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 JEFFERSON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-3703
Mailing Address - Country:US
Mailing Address - Phone:910-508-8904
Mailing Address - Fax:910-640-0026
Practice Address - Street 1:823 JEFFERSON ST STE 1
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3703
Practice Address - Country:US
Practice Address - Phone:910-508-8904
Practice Address - Fax:910-640-0026
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-12
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-3272101YA0400X
NC9883101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)