Healthcare Provider Details

I. General information

NPI: 1871258392
Provider Name (Legal Business Name): REBECCA LYNN GRZADZINSKI PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 RENEE LYNN CT
CARRBORO NC
27510-6511
US

IV. Provider business mailing address

101 RENEE LYNN CT
CARRBORO NC
27510-6511
US

V. Phone/Fax

Practice location:
  • Phone: 919-717-2543
  • Fax:
Mailing address:
  • Phone: 919-717-2543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5975
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: