Healthcare Provider Details

I. General information

NPI: 1841546041
Provider Name (Legal Business Name): KEVIN RAJAN KURIAN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15801 BRIXHAM HILL AVE STE 475
CHARLOTTE NC
28277-0878
US

IV. Provider business mailing address

15801 BRIXHAM HILL AVE STE 475
CHARLOTTE NC
28277-0878
US

V. Phone/Fax

Practice location:
  • Phone: 704-251-9084
  • Fax: 877-513-7720
Mailing address:
  • Phone: 704-251-9084
  • Fax: 877-513-7720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6101
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number37575
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number37575
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1764
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6101
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: