Provider Demographics
NPI:1922270297
Name:BAGLEY, JAMES (MA, LCAS, CSAC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:BAGLEY
Suffix:
Gender:M
Credentials:MA, LCAS, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 FALCON RUN
Mailing Address - Street 2:
Mailing Address - City:MIDDLESEX
Mailing Address - State:NC
Mailing Address - Zip Code:27557-9361
Mailing Address - Country:US
Mailing Address - Phone:919-915-6322
Mailing Address - Fax:919-284-0366
Practice Address - Street 1:204 FALCON RUN
Practice Address - Street 2:
Practice Address - City:MIDDLESEX
Practice Address - State:NC
Practice Address - Zip Code:27557-9361
Practice Address - Country:US
Practice Address - Phone:919-915-6322
Practice Address - Fax:919-284-0366
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1205101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)