Provider Demographics
NPI:1427162676
Name:BAXENDALE, JAMES D (PHD, CTS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:BAXENDALE
Suffix:
Gender:M
Credentials:PHD, CTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 SWEET SAMANTHA CT
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-5054
Mailing Address - Country:US
Mailing Address - Phone:704-290-7527
Mailing Address - Fax:
Practice Address - Street 1:64 SWEET SAMANTHA CT
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-5054
Practice Address - Country:US
Practice Address - Phone:704-290-7527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10653101YP2500X
VT068.0099603101YM0800X
NY002890-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health