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General NPI Number Information
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NPI Number | 1770133548
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Entity Type | Individual
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Provider Name | CHARLES BENJAMIN JARDIN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 09/13/2019
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 960 CORPORATE DR STE 201
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City | HILLSBOROUGH
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State | NC
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Zip | 27278-8560
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Country | US
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Telephone | 919-286-0411
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Fax |
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Provider Business Mailing Address
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Address Line | 204 DOGWOOD BLOOM LN
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City | HILLSBOROUGH
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State | NC
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Zip | 27278-9095
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Country | US
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Telephone | 919-672-7750
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Fax |
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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 | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number |
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 5606
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License Number State | NC
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