Provider Demographics
NPI:1326073966
Name:WYATT, LAURA W (PHD)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:W
Last Name:WYATT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 MERTON DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6609
Mailing Address - Country:US
Mailing Address - Phone:919-789-8989
Mailing Address - Fax:919-789-8988
Practice Address - Street 1:3820 MERTON DR
Practice Address - Street 2:SUITE 205
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6609
Practice Address - Country:US
Practice Address - Phone:919-789-8989
Practice Address - Fax:919-789-8988
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2237103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist