Healthcare Provider Details

I. General information

NPI: 1689098774
Provider Name (Legal Business Name): PSYCHOLOGICAL MOBILE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S ELLINGTON ST
CLAYTON NC
27520-2305
US

IV. Provider business mailing address

779 TRUE VINE RD NE
PIKEVILLE NC
27863-8800
US

V. Phone/Fax

Practice location:
  • Phone: 252-291-0735
  • Fax:
Mailing address:
  • Phone: 919-252-4816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3681
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0389
License Number StateNC

VIII. Authorized Official

Name: DR. STEVEN HANNANT
Title or Position: OWNER
Credential: PSYD
Phone: 919-252-8896