Healthcare Provider Details

I. General information

NPI: 1114292158
Provider Name (Legal Business Name): FERZIN RUSTOM IRANI LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 WAKE FOREST ROAD SUITE 200
RALEIGH NC
27609
US

IV. Provider business mailing address

1002 WILLOW DR APT 27
CHAPEL HILL NC
27514-2934
US

V. Phone/Fax

Practice location:
  • Phone: 919-872-1441
  • Fax: 919-872-1455
Mailing address:
  • Phone: 714-287-8163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1428
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: