Provider Demographics
NPI:1790191997
Name:TRUMBULL, NANCY WHITLOW (LPCA)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:WHITLOW
Last Name:TRUMBULL
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:WHIT
Other - Middle Name:
Other - Last Name:TRUMBULL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6208 FAYETTEVILLE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6286
Mailing Address - Country:US
Mailing Address - Phone:919-597-0171
Mailing Address - Fax:
Practice Address - Street 1:6208 FAYETTEVILLE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6286
Practice Address - Country:US
Practice Address - Phone:919-597-0171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8064101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional