Provider Demographics
NPI:1336997881
Name:MANSOUR, ANITA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:MANSOUR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7406 CHAPEL HILL RD STE G&H
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-5077
Mailing Address - Country:US
Mailing Address - Phone:919-213-8548
Mailing Address - Fax:
Practice Address - Street 1:7406 CHAPEL HILL RD STE G&H
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-5077
Practice Address - Country:US
Practice Address - Phone:919-213-8548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPA6555103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty