Individual
JEREMY PHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS
Contact information
Practice address
2006 S MAIN ST STE 206, WAKE FOREST, NC 27587-9391
(919) 671-6438
Mailing address
2006 S MAIN ST STE 206, WAKE FOREST, NC 27587-9391
(919) 671-6438
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
17961
NC
101YM0800X
Mental Health Counselor
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Other
Enumeration date
06/03/2022
Last updated
12/06/2024
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