Provider Demographics
NPI:1821073354
Name:INMAN CONRAD, MARGARET L (PHD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:L
Last Name:INMAN CONRAD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:M.
Other - Middle Name:LORI
Other - Last Name:INMAN CONRAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:104 S WHITE ST
Mailing Address - Street 2:STE 204
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-2773
Mailing Address - Country:US
Mailing Address - Phone:919-562-8088
Mailing Address - Fax:919-562-8088
Practice Address - Street 1:104 S WHITE ST
Practice Address - Street 2:STE 204
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-2773
Practice Address - Country:US
Practice Address - Phone:919-562-8088
Practice Address - Fax:919-562-8088
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3058103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000638Medicaid
NC046K6OtherBLUE CROSS BLUE SHIELD ID
NC6000638Medicaid