Provider Demographics
NPI:1982171658
Name:NAHAL C KAIVAN PH D PLLC
Entity Type:Organization
Organization Name:NAHAL C KAIVAN PH D PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAHAL
Authorized Official - Middle Name:CRYSTAL
Authorized Official - Last Name:KAIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-283-8925
Mailing Address - Street 1:911 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4141
Mailing Address - Country:US
Mailing Address - Phone:919-289-8925
Mailing Address - Fax:
Practice Address - Street 1:911 BROAD ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4141
Practice Address - Country:US
Practice Address - Phone:919-289-8925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty