Healthcare Provider Details

I. General information

NPI: 1578167201
Provider Name (Legal Business Name): PROJECT YES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MARTIN LUTHER KING PKWY STE 100
DURHAM NC
27707-3500
US

IV. Provider business mailing address

1521 N DUKE ST
DURHAM NC
27701-1238
US

V. Phone/Fax

Practice location:
  • Phone: 919-355-5633
  • Fax:
Mailing address:
  • Phone: 919-355-5633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: TATYANA KHOLODKOV
Title or Position: OWNER
Credential: PH.D.
Phone: 919-355-5633