Individual
MR. JONATHON BLOCKER PAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS LPC NCC
Contact information
Practice address
107 INDUSTRIAL DR, LOUISBURG, NC 27549-2371
(919) 496-3444
(919) 496-6452
Mailing address
2921 CARRIAGE MEADOWS DR, WAKE FOREST, NC 27587-7331
(919) 496-3444
(919) 496-6452
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
4724
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6102735
—
NC
Enumeration date
07/23/2007
Last updated
07/23/2007
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