Provider Demographics
NPI:1700324191
Name:DESART, JAMES (LPC-A)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:DESART
Suffix:
Gender:M
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8344 CAROB TREE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-7142
Mailing Address - Country:US
Mailing Address - Phone:704-840-4077
Mailing Address - Fax:704-973-9287
Practice Address - Street 1:415 W MAIN AVE
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-3844
Practice Address - Country:US
Practice Address - Phone:704-478-6093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12596101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional