Healthcare Provider Details

I. General information

NPI: 1306376033
Provider Name (Legal Business Name): CLOYD PSYCHOLOGICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 REGENCY PKWY
CARY NC
27518-8549
US

IV. Provider business mailing address

8693 FORESTER LN
APEX NC
27539-7933
US

V. Phone/Fax

Practice location:
  • Phone: 919-924-1668
  • Fax:
Mailing address:
  • Phone: 919-924-1668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LISA CLOYD
Title or Position: OWNER
Credential:
Phone: 919-924-1668