Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 2596 | NC |
N | 103T00000X | Psychologist | 2596 | NC |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 2596 | NC |
Y | 103G00000X | Clinical Psychologist | 2596 | NC |
Y | 103TC0700X | Clinical Psychologist | 2596 | NC |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 2596 | NC |
N | 103TH0100X | Health Service | 2596 | NC |
NPI | 1306910781 |
---|---|
Provider Name | Mr. Anya Onuoha Odim |
First Address | Durham, NC 27713-3127 |
Second Address | Durham, NC 27707-2567 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 21/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6107416 | (05) | NC |