Individual
IDA HAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6815 FAYETTEVILLE RD STE 202, DURHAM, NC 27713-7082
(919) 544-3907
Mailing address
6815 FAYETTEVILLE RD STE 202, DURHAM, NC 27713-7082
(919) 544-3907
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCAS-22527
NC
101YM0800X
Mental Health Counselor
Primary
13961
NC
101YS0200X
School Counselor
741911
NC
Other
Enumeration date
05/12/2016
Last updated
09/03/2024
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