Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 807 | NC |
Y | 103TC0700X | Clinical Psychologist | 807 | NC |
NPI | 1013005701 |
---|---|
Provider Name | Prof. Mary E Vanbourgondien |
First Address | Chapel Hill, NC 27516-2539 |
Second Address | Chapel Hill, NC 27599-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 23/04/2021 |