Eccleston, Jon Wayne

Eccleston, Jon Wayne is an sole proprietor health care provider with primary practice located at 124 Unionville Indian Trl Rd W Suite A1, Indian Trail NC 28079-5591. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Eccleston, Jon Wayne can be contacted via phone (704) 608-0445.

Contact Information

Primary practice address
124 Unionville Indian Trl Rd W Suite A1 Indian Trail NC 28079-5591
Phone: (704) 608-0445
Fax: (704) 821-9337
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X C004734 North Carolina

Profile Details

NPI number 1306937750
LBN Legal business name Eccleston, Jon Wayne
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 28th, 2006
Last updated Sep 21st, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306937750 NPPES
North Carolina Other C004734 NC CLINICAL SOCIAL WORK
North Carolina MEDICAID 600913 NC CLINICAL SOCIAL WORK

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