Healthcare Provider Details

I. General information

NPI: 1144747452
Provider Name (Legal Business Name): PRISM PSYCHOLOGICAL SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8212 VILLAGE HARBOR DR
CORNELIUS NC
28031-3706
US

IV. Provider business mailing address

8212 VILLAGE HARBOR DR
CORNELIUS NC
28031-3706
US

V. Phone/Fax

Practice location:
  • Phone: 704-212-2020
  • Fax: 704-212-2020
Mailing address:
  • Phone: 704-212-2020
  • Fax: 704-212-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4903
License Number StateNC

VIII. Authorized Official

Name: DR. RONALD FIELD
Title or Position: PRESIDENT
Credential: PHD
Phone: 704-212-2020