| NPI | 1518158757 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELWOOD JOHNSON BURGESS President 919-785-9944 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NC 2249) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NC 2249) |
| 103T00000X Psychologist (Licence: NC 2249) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NC 2249) | |
| 103TF0200X Psychologist Forensic (Licence: NC 2249) | |
| 103TR0400X Psychologist Rehabilitation (Licence: NC 2249) | |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2013-09-10 |