Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 2425 | NC |
Y | 103TC0700X | Clinical Psychologist | 2425 | NC |
NPI | 1003025685 |
---|---|
Provider Name | Mrs. Betty-Shannon Prevatt |
First Address | Cary, NC 27513-4972 |
Second Address | Raleigh, NC 27607-6688 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 16/04/2008 |