Healthcare Provider Details

I. General information

NPI: 1679621833
Provider Name (Legal Business Name): GAEL DIANE-ELIZABETH MCCARTHY PH.D., B.C.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 W CHAPEL HILL ST SUITE 908
DURHAM NC
27701-3616
US

IV. Provider business mailing address

3501 CAMBRIDGE RD
DURHAM NC
27707-4509
US

V. Phone/Fax

Practice location:
  • Phone: 919-419-3474
  • Fax: 919-419-3474
Mailing address:
  • Phone: 919-403-0398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC000228
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: