Provider Demographics
NPI:1346510864
Name:DRISCOLL, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7408 HOLLY SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-4333
Mailing Address - Country:US
Mailing Address - Phone:919-412-9919
Mailing Address - Fax:
Practice Address - Street 1:1125 KILDAIRE FARM RD
Practice Address - Street 2:SUITE 202
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4566
Practice Address - Country:US
Practice Address - Phone:919-380-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-02
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC444103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool