Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 2675 | NC |
NPI | 1033139456 |
---|---|
Provider Name | Dr. Lise Leigh Osvold |
First Address | Raleigh, NC 27603-2159 |
Second Address | Raleigh, NC 27612-7623 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6000547 | (05) | NC |