Provider Demographics
NPI:1326596453
Name:RICKEL, KATIE ALLISON (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:ALLISON
Last Name:RICKEL
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 1:1 MONACO CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6106
Mailing Address - Country:US
Mailing Address - Phone:215-530-8180
Mailing Address - Fax:
Practice Address - Street 1:1 MONACO CT
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6106
Practice Address - Country:US
Practice Address - Phone:215-530-8180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3790103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical