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Contact Information

LAVENDER AVENUE THERAPEUTICS, PC
210 W LAVENDER AVE
DURHAM, NC27704-4251
 Phone: 919-302-2308
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

103TC0700X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for LAVENDER AVENUE THERAPEUTICS, PC

NPI Number 1891174181
LBN Legal business name LAVENDER AVENUE THERAPEUTICS, PC
Authorized official JASMINE IRVIN - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 05/20/2015
Last updated 05/20/2015 - About 11 years ago
Identifiers
NC License # 4548
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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