Provider Demographics
NPI:1417772237
Name:CONTRERAS, GUILE JONATHAN
Entity type:Individual
Prefix:
First Name:GUILE
Middle Name:JONATHAN
Last Name:CONTRERAS
Suffix:
Gender:M
Credentials:
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 981
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NC
Mailing Address - Zip Code:27830-0981
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:206 N VANCE STREET
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NC
Practice Address - Zip Code:27830
Practice Address - Country:US
Practice Address - Phone:919-200-8685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19126101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health