Basic Information
| Provider Information | |||||||||
| NPI: | 1528091493 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEVEREUX | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | CONRAD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHD, JD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2511 OLD CORNWALLIS RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277131869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199325700 | ||||||||
| FaxNumber: | 9199336881 | ||||||||
| Practice Location | |||||||||
| Address1: | 2511 OLD CORNWALLIS RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277131869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199325700 | ||||||||
| FaxNumber: | 9199336881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 07/26/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 4704 | NC | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.