Individual
MR. JEFFERY BRYANT EADS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
351 RIVERSIDE DR, MOUNT AIRY, NC 27030-3850
(336) 786-7079
Mailing address
218 ORCHARD ST, MOUNT AIRY, NC 27030-2812
(336) 786-2336
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
4697
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6102538
—
NC
Enumeration date
01/20/2007
Last updated
07/08/2007
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