Provider Demographics
NPI:1982717260
Name:COLWELL, JAMES TRAVIS (PHD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:TRAVIS
Last Name:COLWELL
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 1:2800 ASHTON DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2486
Mailing Address - Country:US
Mailing Address - Phone:910-794-8892
Mailing Address - Fax:910-794-8895
Practice Address - Street 1:2800 ASHTON DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2486
Practice Address - Country:US
Practice Address - Phone:910-794-8892
Practice Address - Fax:910-794-8895
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2564103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000326Medicaid
NC2820381Medicare ID - Type Unspecified