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Clinical Neuropsychologist

Charlotte, North Carolina

Provider NPI: 1235118654

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
1718 E 4TH ST SUITE 702 CHARLOTTE, NC 28204 US
Tel: 704-372-5997  Fax: 704-372-2330

Business Mailing Address:
1718 E 4TH ST SUITE 702 CHARLOTTE, NC 28204 US
Tel: 704-372-5997  Fax: 704-372-2330

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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