Provider Demographics
NPI:1508287822
Name:CHILD AND FAMILY PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:CHILD AND FAMILY PSYCHIATRY PLLC
Other - Org Name:HIMA PALAKURTHI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALAKURTHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:919-414-1334
Mailing Address - Street 1:5904 NORWOOD KNOLLS WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8296
Mailing Address - Country:US
Mailing Address - Phone:919-414-1334
Mailing Address - Fax:919-676-9946
Practice Address - Street 1:8300 HEALTH PARK
Practice Address - Street 2:201
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4730
Practice Address - Country:US
Practice Address - Phone:919-414-1334
Practice Address - Fax:919-676-9946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-05
Last Update Date:2014-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-000302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905884Medicaid