Provider Demographics
NPI:1629216460
Name:RYDIN-GRAY, SOFIA HELEN (PHD)
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:HELEN
Last Name:RYDIN-GRAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3888
Mailing Address - Country:US
Mailing Address - Phone:919-684-4692
Mailing Address - Fax:
Practice Address - Street 1:501 DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3888
Practice Address - Country:US
Practice Address - Phone:919-684-4692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3619103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical