Provider Demographics
NPI:1053353524
Name:PRAKKEN, KATHERINE FELLNER (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:FELLNER
Last Name:PRAKKEN
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 1:104 S ESTES DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2866
Mailing Address - Country:US
Mailing Address - Phone:919-933-3773
Mailing Address - Fax:
Practice Address - Street 1:104 S ESTES DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2866
Practice Address - Country:US
Practice Address - Phone:919-933-3773
Practice Address - Fax:919-969-0068
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2863103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical