Healthcare Provider Details

I. General information

NPI: 1205216181
Provider Name (Legal Business Name): PSYCHOLOGICAL SERVICES OF CINDY C. COTTLE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 FAIR MEADOWS LN STE 106
RALEIGH NC
27607-6465
US

IV. Provider business mailing address

4505 FAIR MEADOWS LN STE 106
RALEIGH NC
27607-6465
US

V. Phone/Fax

Practice location:
  • Phone: 919-301-8513
  • Fax: 919-882-1685
Mailing address:
  • Phone: 919-301-8513
  • Fax: 919-882-1685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3061
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number3061
License Number StateNC

VIII. Authorized Official

Name: CINDY C COTTLE
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 919-301-8513