Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 103TC0700X | Psychologist | Clinical | 412 | NORTH CAROLINA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 51751 | OTHER | NORTH CAROLINA | CIGNA BEHAVIORAL HEALTH # |
| 2 | 51751 | OTHER | NORTH CAROLINA | CIGNA PROVIDER NUMBER |
| 3 | 2810160 | MEDICARE ID-TYPE UNSPECIFIED | NORTH CAROLINA | MEDICARE PROVIDER NUMBER |
| 4 | 192530000 | OTHER | NORTH CAROLINA | MAGELLEN PROVIDER NUMBER |
| 5 | A314799 | OTHER | NORTH CAROLINA | VALUE OPTIONS GROUP # |
| 6 | B5436 | OTHER | NORTH CAROLINA | MEDCOST PROVIDER NUMBER |
| 7 | 03655 | OTHER | NORTH CAROLINA | BLUE CROSS BLUE SHIELD # |
| 8 | 4279018 | OTHER | NORTH CAROLINA | AETNA PROVIDER NUMBER |
| 9 | 066683 | OTHER | NORTH CAROLINA | VALUE OPTIONS PROVIDER # |
| 10 | 12748 | OTHER | NORTH CAROLINA | PARNTERS NATIONAL HEALTH |
| 11 | 6000123 | MEDICAID | NORTH CAROLINA | |
