Provider Demographics
NPI:1013290360
Name:CARR, JAMES DUQUE
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DUQUE
Last Name:CARR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 GROVE STREET
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92945
Mailing Address - Country:US
Mailing Address - Phone:619-889-4607
Mailing Address - Fax:619-797-1091
Practice Address - Street 1:3434 GROVE ST
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-1812
Practice Address - Country:US
Practice Address - Phone:619-889-4607
Practice Address - Fax:619-797-1091
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26026101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health