Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | LCAS-20592 | NC |
N | 102L00000X | Psychologist | 5073 | NC |
N | 103T00000X | Psychologist | 5073 | NC |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 5073 | NC |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 5073 | NC |
N | 103G00000X | Clinical Psychologist | 5073 | NC |
N | 103TC0700X | Clinical Psychologist | 5073 | NC |
N | 103TC1900X | Counseling Psychologist | 5073 | NC |
N | 103TE1100X | Exercise & Sports Psychologist | 5073 | NC |
Y | 103TF0200X | Forensic Psychologist | 5073 | NC |
NPI | 1215401401 |
---|---|
Provider Name | John Winters Baley |
First Address | Chapel Hill, NC 27514-7000 |
Second Address | Raleigh, NC 27606-2148 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2019 |
Last Update Date | 22/01/2019 |