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General NPI Number Information
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NPI Number | 1871076406
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Entity Type | Organization
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Legal Business Name | BREYTA PSYCHOLOGICAL SERVICES, P.A.
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Dates
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Enumeration Date | 09/10/2018
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Last Update Date | 01/22/2021
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Provider Practice Location Address
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Address Line | 8303 SIX FORKS RD STE 207
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City | RALEIGH
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State | NC
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Zip | 27615-3094
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Country | US
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Telephone | 919-245-7791
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Fax | 919-867-2786
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Provider Business Mailing Address
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Address Line | 8303 SIX FORKS RD STE 207
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City | RALEIGH
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State | NC
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Zip | 27615-3094
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Country | US
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Telephone | 919-245-7791
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Fax | 919-867-2786
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Authorized Official
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Title or Position | OWNER
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Name | DR. VANESSA HANDSEL RODDENBERRY
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Credential | PHD
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Telephone | 919-245-7791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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