Provider Demographics
NPI:1689701385
Name:BYASSEE, JAMES (PHD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BYASSEE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 E POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-1709
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18 W COLONY PL
Practice Address - Street 2:SUITE 280
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-5582
Practice Address - Country:US
Practice Address - Phone:919-493-2674
Practice Address - Fax:919-493-1923
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC535103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000114Medicaid
NC6000114Medicaid