Provider Demographics
NPI:1720292154
Name:PEROT, ANNETTE R (PHD)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:R
Last Name:PEROT
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 1:1415 W NC HIGHWAY 54
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5577
Mailing Address - Country:US
Mailing Address - Phone:919-493-1975
Mailing Address - Fax:866-713-8253
Practice Address - Street 1:1415 W NC HIGHWAY 54
Practice Address - Street 2:SUITE 201
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5577
Practice Address - Country:US
Practice Address - Phone:919-493-1975
Practice Address - Fax:866-713-8253
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2318103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral