Healthcare Provider Details

I. General information

NPI: 1982811303
Provider Name (Legal Business Name): MERLE (AKA MARDY) SANDERS IRELAND PH,D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MERLE (MARDY) SANDERS IRELAND PH.D

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3733 NATIONAL DR 114
RALEIGH NC
27612-4065
US

IV. Provider business mailing address

3733 NATIONAL DR 114
RALEIGH NC
27612-4065
US

V. Phone/Fax

Practice location:
  • Phone: 919-821-3635
  • Fax:
Mailing address:
  • Phone: 919-821-3635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3254
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: