Healthcare Provider Details

I. General information

NPI: 1720821077
Provider Name (Legal Business Name): PRESTON NEUROPSYCHOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5317 HIGHGATE DR STE 213
DURHAM NC
27713-6622
US

IV. Provider business mailing address

7419 MONTIBILLO PKWY
DURHAM NC
27713-8891
US

V. Phone/Fax

Practice location:
  • Phone: 984-287-8998
  • Fax:
Mailing address:
  • Phone: 984-287-8998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: ANDREW S PRESTON
Title or Position: OWNER
Credential:
Phone: 984-287-8998