Provider Demographics
NPI:1982811303
Name:IRELAND, MERLE (AKA MARDY) SANDERS (PH,D)
Entity Type:Individual
Prefix:DR
First Name:MERLE (AKA MARDY)
Middle Name:SANDERS
Last Name:IRELAND
Suffix:
Gender:F
Credentials:PH,D
Other - Prefix:DR
Other - First Name:MERLE (MARDY)
Other - Middle Name:SANDERS
Other - Last Name:IRELAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3733 NATIONAL DR
Mailing Address - Street 2:114
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-4065
Mailing Address - Country:US
Mailing Address - Phone:919-821-3635
Mailing Address - Fax:
Practice Address - Street 1:3733 NATIONAL DR
Practice Address - Street 2:114
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4065
Practice Address - Country:US
Practice Address - Phone:919-821-3635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3254103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3254OtherNORTH CAROLINA PSYCHOLOGY LICENSE