Healthcare Provider Details

I. General information

NPI: 1750713194
Provider Name (Legal Business Name): NEXT STEP PSYCHOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5318 HIGHGATE DR SUITE 132
DURHAM NC
27713-6630
US

IV. Provider business mailing address

5318 HIGHGATE DR SUITE 132
DURHAM NC
27713-6630
US

V. Phone/Fax

Practice location:
  • Phone: 919-228-8845
  • Fax:
Mailing address:
  • Phone: 919-228-8845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3845
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number3845
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3845
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number3845
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number3845
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3845
License Number StateNC
# 7
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number3845
License Number State

VIII. Authorized Official

Name: DR. CAROLYN PENDER ROCHE
Title or Position: LICENSED PSYCHOLOGIST
Credential: PH.D., NCSP
Phone: 919-228-8845