Healthcare Provider Details

I. General information

NPI: 1639094469
Provider Name (Legal Business Name): ESTEBAN GALVIS SERNA PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8504 DARTON WAY STE 101
RALEIGH NC
27616-9317
US

IV. Provider business mailing address

121 WATERTREE LN
APEX NC
27502-4180
US

V. Phone/Fax

Practice location:
  • Phone: 919-261-7786
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPA7085
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: