Organization
SOUTHEAST FAMILY SERVICES OF RALEIGH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA VATH (OFFICE MANAGER)
(919) 783-8846
Entity
Organization
Contact information
Practice address
3716 NATIONAL DR, SUITE 124, RALEIGH, NC 27612-4068
(919) 783-8846
(919) 783-7305
Mailing address
3716 NATIONAL DR, SUITE 124, RALEIGH, NC 27612-4068
(919) 783-8846
(919) 783-7305
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
3757
NC
225XP0200X
Pediatric Occupational Therapist
5028
NC
235Z00000X
Speech-Language Pathologist
6834
NC
Other
Enumeration date
05/26/2011
Last updated
05/26/2011
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