Healthcare Provider Details

I. General information

NPI: 1083629745
Provider Name (Legal Business Name): JUDITH CLAIRE HOLDER-COOPER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUDITH CLAIRE HOLDER PH.D.

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 W MAIN ST SUITE 400A
DURHAM NC
27705-4640
US

IV. Provider business mailing address

2200 W MAIN ST SUITE 400A
DURHAM NC
27705-4640
US

V. Phone/Fax

Practice location:
  • Phone: 919-286-1244
  • Fax: 919-286-1121
Mailing address:
  • Phone: 919-286-1244
  • Fax: 919-286-1121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2321
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: