Provider Demographics
NPI:1194170746
Name:PERRY, JASON (MS)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:PERRY
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 NC HIGHWAY 33 W
Mailing Address - Street 2:
Mailing Address - City:CHOCOWINITY
Mailing Address - State:NC
Mailing Address - Zip Code:27817-8023
Mailing Address - Country:US
Mailing Address - Phone:252-414-7372
Mailing Address - Fax:
Practice Address - Street 1:276 NC HIGHWAY 33 W
Practice Address - Street 2:
Practice Address - City:CHOCOWINITY
Practice Address - State:NC
Practice Address - Zip Code:27817-8023
Practice Address - Country:US
Practice Address - Phone:252-414-7372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12298101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health