Provider Demographics
NPI:1902399223
Name:IRWIN, IAIN KNOX NATHANIEL (LFMT)
Entity type:Individual
Prefix:
First Name:IAIN
Middle Name:KNOX NATHANIEL
Last Name:IRWIN
Suffix:
Gender:M
Credentials:LFMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6004 CHITTIM CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-5456
Mailing Address - Country:US
Mailing Address - Phone:847-323-6431
Mailing Address - Fax:
Practice Address - Street 1:3301 ATLANTIC AVE STE 107
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1658
Practice Address - Country:US
Practice Address - Phone:919-590-3062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12098A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist