Provider Demographics
NPI:1417390444
Name:DURHAM DBT, INC.
Entity Type:Organization
Organization Name:DURHAM DBT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:FAWZY
Authorized Official - Last Name:BANAWAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-627-8675
Mailing Address - Street 1:5850 FAYETTEVILLE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6289
Mailing Address - Country:US
Mailing Address - Phone:919-627-8675
Mailing Address - Fax:
Practice Address - Street 1:5850 FAYETTEVILLE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6289
Practice Address - Country:US
Practice Address - Phone:919-627-8675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty