Healthcare Provider Details

I. General information

NPI: 1285971374
Provider Name (Legal Business Name): CATAWBA VALLEY PSYCHOLOGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211-B HIGHWAY 127 S.E., SUITE 130
HICKORY NC
28602-3541
US

IV. Provider business mailing address

75 BROWNING DR
TAYLORSVILLE NC
28681-6642
US

V. Phone/Fax

Practice location:
  • Phone: 828-848-8278
  • Fax: 828-270-7868
Mailing address:
  • Phone: 828-848-8278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3679
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3679
License Number StateNC

VIII. Authorized Official

Name: MRS. ROBERTA ANN SHANNON-KIRBY
Title or Position: PROPRIETOR
Credential: MA/CAS, LPA
Phone: 828-848-8278