Provider Demographics
NPI:1861532822
Name:DURHAM, THOMAS WESLEY (PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WESLEY
Last Name:DURHAM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3787
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27836-1787
Mailing Address - Country:US
Mailing Address - Phone:252-756-7830
Mailing Address - Fax:252-756-7830
Practice Address - Street 1:219 COMMERCE ST STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5031
Practice Address - Country:US
Practice Address - Phone:252-756-7830
Practice Address - Fax:252-756-7830
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC689103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist