Healthcare Provider Details

I. General information

NPI: 1700969748
Provider Name (Legal Business Name): CAROL D. CAPEHART MA, LPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2034 RANDOLPH RD
CHARLOTTE NC
28207-1216
US

IV. Provider business mailing address

1604 NOTTINGHAM DR
GASTONIA NC
28054-5752
US

V. Phone/Fax

Practice location:
  • Phone: 704-332-4834
  • Fax:
Mailing address:
  • Phone: 704-866-9151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0748
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: