Healthcare Provider Details

I. General information

NPI: 1629499819
Provider Name (Legal Business Name): BAY AREA PSYCHOLOGY ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2013
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2457 GUM BRANCH RD STE 800
JACKSONVILLE NC
28540-4008
US

IV. Provider business mailing address

2457 GUM BRANCH RD STE 800
JACKSONVILLE NC
28540-4008
US

V. Phone/Fax

Practice location:
  • Phone: 910-238-2774
  • Fax: 910-387-0757
Mailing address:
  • Phone: 910-238-2774
  • Fax: 910-387-0757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ALLISON BROOKS
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 910-581-5352