Provider Demographics
NPI:1982685491
Name:FINE, JAY IAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:IAN
Last Name:FINE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 DULA SPRINGS ROAD
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-8323
Mailing Address - Country:US
Mailing Address - Phone:828-645-7738
Mailing Address - Fax:828-254-0358
Practice Address - Street 1:392 DULA SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-8323
Practice Address - Country:US
Practice Address - Phone:828-645-7738
Practice Address - Fax:828-254-0358
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1749103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6001900Medicaid
NC6000001Medicaid
NC6001900Medicaid