Healthcare Provider Details

I. General information

NPI: 1962313882
Provider Name (Legal Business Name): ISABEL LAILA HAZBOUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 SE MAYNARD RD STE 203
CARY NC
27511-6937
US

IV. Provider business mailing address

1200 SE MAYNARD RD STE 203
CARY NC
27511-6937
US

V. Phone/Fax

Practice location:
  • Phone: 252-814-4770
  • Fax:
Mailing address:
  • Phone: 919-379-5788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA23423
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: