Healthcare Provider Details

I. General information

NPI: 1811537210
Provider Name (Legal Business Name): AZEVEDO FAMILY PSYCHOLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 N HARRISON AVE STE 201
CARY NC
27513-3093
US

IV. Provider business mailing address

1903 N HARRISON AVE STE 201
CARY NC
27513-3093
US

V. Phone/Fax

Practice location:
  • Phone: 919-624-9561
  • Fax: 919-404-7124
Mailing address:
  • Phone: 919-624-9561
  • Fax: 919-404-7124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. DON AZEVEDO
Title or Position: OWNER
Credential: PHD
Phone: 919-624-9561