Healthcare Provider Details

I. General information

NPI: 1750360319
Provider Name (Legal Business Name): ALLEVIA PSYCHOLOGICAL SERVICES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 NORTHEAST DR SUITE 19
DAVIDSON NC
28036-7430
US

IV. Provider business mailing address

709 NORTHEAST DR SUITE 19
DAVIDSON NC
28036-7430
US

V. Phone/Fax

Practice location:
  • Phone: 704-987-1617
  • Fax: 704-987-0534
Mailing address:
  • Phone: 704-987-1617
  • Fax: 704-987-0534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2596
License Number StateNC

VIII. Authorized Official

Name: DR. NANCY LOUISE MILLER
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 704-987-1617