Provider Demographics
NPI:1396962940
Name:WAX, TOVAH M (PH D)
Entity type:Individual
Prefix:
First Name:TOVAH
Middle Name:M
Last Name:WAX
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N ATLEY LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-4131
Mailing Address - Country:US
Mailing Address - Phone:919-465-3985
Mailing Address - Fax:
Practice Address - Street 1:110 N ATLEY LN
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-4131
Practice Address - Country:US
Practice Address - Phone:919-465-3985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2515103TC0700X
NCCOO32921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical