| Lavender Avenue Therapeutics, Pc | |
|
210 W Lavender Ave Durham NC 27704-4251 | |
| (919) 302-2308 | |
| Not Available |
| Full Name | Lavender Avenue Therapeutics, Pc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 210 W Lavender Ave, Durham, North Carolina |
| Authorized Official Name and Position | Jasmine T Irvin (PRESIDENT) |
| Authorized Official Contact | 9193022308 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lavender Avenue Therapeutics, Pc 210 W Lavender Ave Durham NC 27704-4251 Ph: (919) 302-2308 | Lavender Avenue Therapeutics, Pc 210 W Lavender Ave Durham NC 27704-4251 Ph: (919) 302-2308 |
| NPI Number | 1891174181 |
|---|---|
| Provider Enumeration Date | 05/20/2015 |
| Last Update Date | 05/20/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891174181 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 4548 (North Carolina) | Primary |
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