Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 1768 | NC |
N | 103T00000X | Psychologist | 1768 | NC |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 1768 | NC |
N | 103TH0100X | Health Service | 1768 | NC |
Y | 103TM1800X | Intellectual & Developmental Disabilities | 1768 | NC |
NPI | 1619145257 |
---|---|
Provider Name | Tina Lanier Barrett |
First Address | Raleigh, NC 27617-4796 |
Second Address | Greensboro, NC 27406-3342 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2008 |
Last Update Date | 16/08/2019 |