Healthcare Provider Details

I. General information

NPI: 1619145257
Provider Name (Legal Business Name): TINA LANIER BARRETT MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TINA MARGARETE LANIER

II. Dates (important events)

Enumeration Date: 02/18/2008
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 MARTIN LUTHER KING JR DR
GREENSBORO NC
27406-3342
US

IV. Provider business mailing address

9830 WYNGATE RIDGE DR
RALEIGH NC
27617-4796
US

V. Phone/Fax

Practice location:
  • Phone: 919-632-7641
  • Fax:
Mailing address:
  • Phone: 919-400-8493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1768
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1768
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number1768
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number1768
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: