Provider Demographics
NPI:1215060975
Name:BAIN, DAVID ALFRED JR (MA, CSAC, LCAS)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALFRED
Last Name:BAIN
Suffix:JR
Gender:M
Credentials:MA, CSAC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:137 TORREY PINES DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-5301
Mailing Address - Country:US
Mailing Address - Phone:919-231-5545
Mailing Address - Fax:919-550-9438
Practice Address - Street 1:220 SWINBURNE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1834
Practice Address - Country:US
Practice Address - Phone:919-231-5545
Practice Address - Fax:919-212-7191
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC957101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6111830Medicaid