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General NPI Number Information
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NPI Number | 1891223251
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Entity Type | Individual
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Provider Name | IAN JOSEPH PALOMBO EDD, MA, LCMHC, LPC
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Gender | Male
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Dates
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Enumeration Date | 05/30/2017
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Last Update Date | 01/23/2026
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Provider Practice Location Address
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Address Line | 1200 BROAD ST STE 101
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City | DURHAM
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State | NC
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Zip | 27705-3576
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Country | US
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Telephone | 919-699-8282
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 BROAD ST STE 101
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City | DURHAM
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State | NC
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Zip | 27705-3576
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Country | US
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Telephone | 919-699-8282
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0013763
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 21433
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License Number State | NC
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