Provider Demographics
NPI:1326478058
Name:HARRELL, WAVERLY RACHEL (PHD)
Entity Type:Individual
Prefix:
First Name:WAVERLY
Middle Name:RACHEL
Last Name:HARRELL
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 1:4125 BEN FRANKLIN BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2167
Mailing Address - Country:US
Mailing Address - Phone:919-479-1600
Mailing Address - Fax:919-479-5551
Practice Address - Street 1:4125 BEN FRANKLIN BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2167
Practice Address - Country:US
Practice Address - Phone:919-479-1600
Practice Address - Fax:919-479-5551
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4474103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist