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SOUTHEASTERN PSYCHOLOGICAL SERVICES NPI 1952301079


NPI Information

NPI: 1952301079
Provider Name: SOUTHEASTERN PSYCHOLOGICAL SERVICES
Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 34D0876159

Address:
302 N MAIN ST
FAIRMONT, NC
ZIP 28340
Phone: (910) 628-6718
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SOUTHEASTERN PSYCHOLOGICAL SERVICES is a specialist in Fairmont, NC. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. SOUTHEASTERN PSYCHOLOGICAL SERVICES NPI is 1952301079. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

302 N MAIN ST
FAIRMONT, NC
ZIP 28340-730
Phone: (910) 628-6718
Fax: (910) 628-6719

The provider's authorized official is Linda Oliver-link .
The authorized official title is Administrative Director and has the following contact phone number (910) 682-6718.

The CLIA number assigned to this NPI record is 34D0876159 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 7/29/2005 and was last updated on 7/21/2022.


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
1174400000XSpecialistNORTH CAROLINAYes

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
10384MOTHERNORTH CAROLINABCBS
21318HOTHERNORTH CAROLINABCBS
36005435MEDICAIDNORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.