Healthcare Provider Details

I. General information

NPI: 1982171658
Provider Name (Legal Business Name): NAHAL C KAIVAN PH D PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2018
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 BROAD ST
DURHAM NC
27705-4141
US

IV. Provider business mailing address

911 BROAD ST
DURHAM NC
27705-4141
US

V. Phone/Fax

Practice location:
  • Phone: 919-289-8925
  • Fax:
Mailing address:
  • Phone: 919-289-8925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: NAHAL CRYSTAL KAIVAN
Title or Position: PROVIDER/OWNER
Credential: PHD
Phone: 919-283-8925