Healthcare Provider Details

I. General information

NPI: 1689625386
Provider Name (Legal Business Name): TRIANGLE NEUROPSYCHOLOGY SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 CROASDAILE DR SUITE 400
DURHAM NC
27705-6806
US

IV. Provider business mailing address

3310 CROASDAILE DR SUITE 400
DURHAM NC
27705-6806
US

V. Phone/Fax

Practice location:
  • Phone: 919-384-9682
  • Fax: 919-384-9683
Mailing address:
  • Phone: 919-384-9682
  • Fax: 919-384-9683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2192
License Number StateNC

VIII. Authorized Official

Name: DR. KRISTINE MARIE HERFKENS
Title or Position: OWNER
Credential: PHD
Phone: 919-384-9682