Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 3839 | NC |
Y | 103G00000X | Clinical Psychologist | 3839 | NC |
Y | 103TC0700X | Clinical Psychologist | 3839 | NC |
NPI | 1043544547 |
---|---|
Provider Name | Nina Lea Hayhurst-Chacon |
First Address | Leland, NC 28451-9349 |
Second Address | Wilmington, NC 28401-6637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2009 |
Last Update Date | 10/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6107635 | (05) | NC |