Healthcare Provider Details

I. General information

NPI: 1467409003
Provider Name (Legal Business Name): CAROLINA PSYCHOLOGICAL ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 HIGHWOODS BLVD STE 101
GREENSBORO NC
27410
US

IV. Provider business mailing address

1501 HIGHWOODS BLVD STE 101
GREENSBORO NC
27410
US

V. Phone/Fax

Practice location:
  • Phone: 336-272-0855
  • Fax: 336-272-9885
Mailing address:
  • Phone: 210-881-0890
  • Fax: 210-569-6464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0067
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0067
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0067
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number0067
License Number StateNC

VIII. Authorized Official

Name: GAIL HALE
Title or Position: OFFICE MANAGER
Credential:
Phone: 336-272-0855