Healthcare Provider Details

I. General information

NPI: 1447337290
Provider Name (Legal Business Name): CHAPEL HILL PEDIATRIC PSYCHOLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 SAGE RD SUITE 201
CHAPEL HILL NC
27514-6995
US

IV. Provider business mailing address

205 SAGE RD SUITE 201
CHAPEL HILL NC
27514-6995
US

V. Phone/Fax

Practice location:
  • Phone: 919-942-4166
  • Fax: 919-942-8693
Mailing address:
  • Phone: 919-942-4166
  • Fax: 919-942-8693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID B. RIDDLE JR.
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 919-942-4166