Provider Demographics
NPI:1235783879
Name:PERKINS, FRED DOUGLAS JR (MT-BC)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:DOUGLAS
Last Name:PERKINS
Suffix:JR
Gender:M
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 EXCHANGE GLENWOOD PL APT 8
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5544
Mailing Address - Country:US
Mailing Address - Phone:919-475-2641
Mailing Address - Fax:
Practice Address - Street 1:5868 FARINGDON PL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3931
Practice Address - Country:US
Practice Address - Phone:919-741-3160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11164225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist