Provider Demographics
NPI:1992951545
Name:ACEBO, JUSTIN PAUL (LPC, NCC, MS)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:PAUL
Last Name:ACEBO
Suffix:
Gender:M
Credentials:LPC, NCC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2664 TIMBER DRIVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529
Mailing Address - Country:US
Mailing Address - Phone:919-902-9600
Mailing Address - Fax:
Practice Address - Street 1:5554 NUR LANE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-4060
Practice Address - Country:US
Practice Address - Phone:919-902-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6992101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6992OtherNCBLPC LICENSE NUMBER
NC6104000Medicaid