Provider Demographics
NPI:1780017558
Name:BRACKEN, KATHERINE LEE (PHD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LEE
Last Name:BRACKEN
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 1:8303 SIX FORKS RD STE 207
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3094
Mailing Address - Country:US
Mailing Address - Phone:919-245-7791
Mailing Address - Fax:919-867-2786
Practice Address - Street 1:8303 SIX FORKS RD STE 207
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3094
Practice Address - Country:US
Practice Address - Phone:919-245-7791
Practice Address - Fax:919-867-2786
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4709103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical