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Individual

DR. AUDREY GRACE MASILLA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PH.D.

Contact information

Practice address
916 BORAGE DR, WAKE FOREST, NC 27587-5150
(334) 714-8291
Mailing address
916 BORAGE DR, WAKE FOREST, NC 27587-5150
(334) 714-8291

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
5515
NC

Other

Enumeration date
08/18/2010
Last updated
03/17/2019
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