Provider Demographics
NPI:1316956766
Name:PRATHER, JAMES (LPA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:PRATHER
Suffix:
Gender:M
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-3623
Mailing Address - Country:US
Mailing Address - Phone:828-773-1035
Mailing Address - Fax:
Practice Address - Street 1:525 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-3623
Practice Address - Country:US
Practice Address - Phone:828-773-1035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC609103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107026Medicaid
NC046N9OtherPSYCHOLOGICAL ASSOCIATE