Healthcare Provider Details

I. General information

NPI: 1275707523
Provider Name (Legal Business Name): EMILY R COGDELL HSP-PA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 GREENVILLE BLVD SE SUITE B1
GREENVILLE NC
27858-5758
US

IV. Provider business mailing address

308 GREENVILLE BLVD SE SUITE B-1
GREENVILLE NC
27858-5758
US

V. Phone/Fax

Practice location:
  • Phone: 252-341-4192
  • Fax: 866-309-9297
Mailing address:
  • Phone: 252-341-4192
  • Fax: 866-309-9297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3368
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number3368
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3368
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number1-07-3251
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-07-3251
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: