Provider Demographics
NPI:1508918038
Name:BRISCOE, JAMES W (EDD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
Last Name:BRISCOE
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 S WINSTEAD AVE APT X1
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-3446
Mailing Address - Country:US
Mailing Address - Phone:252-885-4037
Mailing Address - Fax:252-937-6622
Practice Address - Street 1:237 S WINSTEAD AVE APT X1
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3446
Practice Address - Country:US
Practice Address - Phone:252-885-4037
Practice Address - Fax:252-937-6622
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5589101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional