Healthcare Provider Details

I. General information

NPI: 1801222153
Provider Name (Legal Business Name): IARA DE ASSIS OLIVEIRA PAZ MS, NCC, LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: IARA CULPEPPER

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8825 FORESTER LANE
APEX NC
27539
US

IV. Provider business mailing address

8825 FORESTER LANE
APEX NC
27539
US

V. Phone/Fax

Practice location:
  • Phone: 919-602-2209
  • Fax:
Mailing address:
  • Phone: 919-602-2209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9305
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: