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General NPI Number Information
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NPI Number | 1902399223
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Entity Type | Individual
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Provider Name | IAIN KNOX NATHANIEL IRWIN LFMT
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Gender | Male
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Dates
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Enumeration Date | 06/12/2018
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Last Update Date | 06/27/2024
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Provider Practice Location Address
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Address Line | 3301 ATLANTIC AVE STE 107
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City | RALEIGH
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State | NC
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Zip | 27604-1658
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Country | US
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Telephone | 919-590-3062
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Fax |
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Provider Business Mailing Address
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Address Line | 6004 CHITTIM CT
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City | RALEIGH
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State | NC
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Zip | 27616-5456
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Country | US
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Telephone | 847-323-6431
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 12098A
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License Number State | NC
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