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Behavioral Health & Social Service Providers Psychologist Health

Provider NPI: 1063729614

Provider Information:
Gender: F
Not Sole Proprietor

Practice Location:
Tel: 704-905-8712  Fax: --

Business Mailing Address:
7809 HEMLOCK CT  RALEIGH, NC 27615-4909 US
Tel: 704-905-8712  Fax: 866-237-1089

NPI Information:
NPI: 1063729614
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y103TH0004XBehavioral Health & Social Service Providers
N103TH0100XBehavioral Health & Social Service Providers
N103TS0200XBehavioral Health & Social Service Providers

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 103TH0004X





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