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General NPI Number Information
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NPI Number | 1609109586
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Entity Type | Individual
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Provider Name | DAVID GLENN YARBOROUGH III PHD
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Gender | Male
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Dates
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Enumeration Date | 09/10/2009
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Last Update Date | 11/08/2013
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Provider Practice Location Address
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Address Line | 5617 MAXWELL PL
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City | WILMINGTON
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State | NC
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Zip | 28409-2966
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Country | US
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Telephone | 910-742-9243
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Fax | 888-746-1787
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Provider Business Mailing Address
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Address Line | PO BOX 16310
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City | WILMINGTON
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State | NC
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Zip | 28408-6310
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Country | US
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Telephone | 910-742-9243
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Fax | 888-746-1787
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1289
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 412
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License Number State | SC
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