Provider Demographics
NPI:1265647754
Name:DEVRIES, MICHAEL RAY (PHD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RAY
Last Name:DEVRIES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 WHITE OAK CIR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-1350
Mailing Address - Country:US
Mailing Address - Phone:919-498-1715
Mailing Address - Fax:
Practice Address - Street 1:HHC 82ND SB
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09331
Practice Address - Country:IQ
Practice Address - Phone:318-833-1562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1411103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling