Provider Demographics
NPI:1740969666
Name:BARSALEAU, JACOB DAVID
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:DAVID
Last Name:BARSALEAU
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 1:1400 HOLLY HILL DR APT 1417
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6059
Mailing Address - Country:US
Mailing Address - Phone:910-398-0025
Mailing Address - Fax:
Practice Address - Street 1:201 MACKENAN DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6498
Practice Address - Country:US
Practice Address - Phone:919-502-4109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician