Healthcare Provider Details

I. General information

NPI: 1114846680
Provider Name (Legal Business Name): ANAVICTORIA ALFONSO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RIA ALFONSO

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3326 DURHAM CHAPEL HILL BLVD STE 230
DURHAM NC
27707-6239
US

IV. Provider business mailing address

1011 CHESTER ST
DURHAM NC
27701-3815
US

V. Phone/Fax

Practice location:
  • Phone: 919-813-0218
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP023985
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: