Healthcare Provider Details

I. General information

NPI: 1033694781
Provider Name (Legal Business Name): VIRGINIA KATE PROFFIT PHD, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S SALEM ST
APEX NC
27502-1824
US

IV. Provider business mailing address

201 S SALEM ST
APEX NC
27502-1824
US

V. Phone/Fax

Practice location:
  • Phone: 919-303-0377
  • Fax:
Mailing address:
  • Phone: 919-303-0377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4602
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: