Provider Demographics
NPI:1114979069
Name:KRAVETZ, DAVID G (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:KRAVETZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5613 DURALEIGH RD STE 101
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-2694
Mailing Address - Country:US
Mailing Address - Phone:919-599-0536
Mailing Address - Fax:919-477-0283
Practice Address - Street 1:5613 DURALEIGH RD STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-2694
Practice Address - Country:US
Practice Address - Phone:919-599-0536
Practice Address - Fax:919-477-0283
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1056103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical