Healthcare Provider Details

I. General information

NPI: 1619004132
Provider Name (Legal Business Name): AMANDA HARRELL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 N HARRISON AVE SUITE 101
CARY NC
27513-2410
US

IV. Provider business mailing address

1903 N HARRISON AVE SUITE 101
CARY NC
27513-2410
US

V. Phone/Fax

Practice location:
  • Phone: 919-677-0101
  • Fax: 919-677-0113
Mailing address:
  • Phone: 919-677-0101
  • Fax: 919-677-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1067
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: