Healthcare Provider Details

I. General information

NPI: 1831418185
Provider Name (Legal Business Name): NOVA IC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 NORWOOD AVE STE A
GOLDSBORO NC
27534-1601
US

IV. Provider business mailing address

PO BOX 11077
GOLDSBORO NC
27532-1077
US

V. Phone/Fax

Practice location:
  • Phone: 919-734-8803
  • Fax: 919-735-6825
Mailing address:
  • Phone: 919-734-8803
  • Fax: 919-735-6825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0715
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number31639
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL-054-018
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL-096-216
License Number StateNC

VIII. Authorized Official

Name: TRACEY PRIDGEN
Title or Position: CFO
Credential: CPA
Phone: 919-734-8803