Provider Demographics
NPI:1871540575
Name:KONANC, JUDY ANN (PHD)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:ANN
Last Name:KONANC
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:TELLJOHN
Other - Last Name:KONANC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1829 EAST FRANKLIN STREET
Mailing Address - Street 2:SUITE 1200D
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-5838
Mailing Address - Country:US
Mailing Address - Phone:919-967-0049
Mailing Address - Fax:
Practice Address - Street 1:1829 EAST FRANKLIN STREET
Practice Address - Street 2:SUITE 1200D
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-5838
Practice Address - Country:US
Practice Address - Phone:919-967-0049
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC397103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0333COtherBLUE CROSS BLUE SHIELD NC
0333COtherBLUE CROSS BLUE SHIELD NC