Provider Demographics
NPI:1871379925
Name:SCURRY, JAKARA TANISE (MA, LCMHC, LCASA,NCC)
Entity type:Individual
Prefix:
First Name:JAKARA
Middle Name:TANISE
Last Name:SCURRY
Suffix:
Gender:F
Credentials:MA, LCMHC, LCASA,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8118 PRIMANTI BLVD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-7417
Mailing Address - Country:US
Mailing Address - Phone:484-366-8853
Mailing Address - Fax:
Practice Address - Street 1:2815 CATES AVENUE NC STATE COUNSELING CENTER
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27695-0001
Practice Address - Country:US
Practice Address - Phone:919-513-2783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-27426101YA0400X
NC16652101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)