Provider Demographics
NPI:1063606176
Name:KULLEY, JEFFREY C (PHD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:C
Last Name:KULLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 WRIGHTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-5802
Mailing Address - Country:US
Mailing Address - Phone:919-612-4901
Mailing Address - Fax:919-660-1024
Practice Address - Street 1:810 IREDELL ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4120
Practice Address - Country:US
Practice Address - Phone:919-612-4901
Practice Address - Fax:919-660-1024
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2750103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling