Provider Demographics
NPI:1902399223
Name:IRWIN, IAIN KNOX NATHANIEL (LFMTA)
Entity Type:Individual
Prefix:
First Name:IAIN
Middle Name:KNOX NATHANIEL
Last Name:IRWIN
Suffix:
Gender:M
Credentials:LFMTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7701 ALBORZ DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-7402
Mailing Address - Country:US
Mailing Address - Phone:847-323-6431
Mailing Address - Fax:
Practice Address - Street 1:7701 ALBORZ DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612
Practice Address - Country:US
Practice Address - Phone:847-323-6431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12098A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist