Healthcare Provider Details

I. General information

NPI: 1386849313
Provider Name (Legal Business Name): UNCG PSYCHOLOGY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E. NORTHWOOD ST., SUITE 320
GREENSBORO NC
27401
US

IV. Provider business mailing address

PO BOX 26170
GREENSBORO NC
27402-6170
US

V. Phone/Fax

Practice location:
  • Phone: 336-346-3192
  • Fax: 336-346-3197
Mailing address:
  • Phone: 336-346-3192
  • Fax: 336-346-3197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ARTHUR DAVIDE ANASTOPAULOS
Title or Position: DIRECTOR OF AD/HD CLINIC AT UNCG
Credential: PH.D.
Phone: 336-346-3192