Provider Demographics
NPI:1154393395
Name:HARBIN, THOMAS J (PHD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:HARBIN
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 1:2411 ROBESON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5549
Mailing Address - Country:US
Mailing Address - Phone:910-609-1990
Mailing Address - Fax:910-609-1993
Practice Address - Street 1:2411 ROBESON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5549
Practice Address - Country:US
Practice Address - Phone:910-609-1990
Practice Address - Fax:910-609-1993
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1530103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6138588OtherUBH
NC0334AOtherBCBSNC -- INDIVIDUAL
NC015J8OtherBCBSNC -- GROUP
NC175921OtherCOMPSYCH
NC6000311Medicaid
NC015J8OtherBCBSNC -- GROUP
NC0334AOtherBCBSNC -- INDIVIDUAL