Healthcare Provider Details

I. General information

NPI: 1194272815
Provider Name (Legal Business Name): PETER JOHN ADAMS PHD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2016
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 FAYETTEVILLE RD SUITE 211
DURHAM NC
27713-6289
US

IV. Provider business mailing address

5850 FAYETTEVILLE RD SUITE 211
DURHAM NC
27713-6289
US

V. Phone/Fax

Practice location:
  • Phone: 919-294-8981
  • Fax: 919-999-2497
Mailing address:
  • Phone: 919-294-8981
  • Fax: 919-999-2497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number4143
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: