Healthcare Provider Details

I. General information

NPI: 1184666893
Provider Name (Legal Business Name): PEMBROKE PSYCHOLOGICAL SERVICES LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6512 SIX FORKS RD STE 202A
RALEIGH NC
27615-6561
US

IV. Provider business mailing address

6512 SIX FORKS RD STE 202A
RALEIGH NC
27615-6561
US

V. Phone/Fax

Practice location:
  • Phone: 919-846-9142
  • Fax: 919-846-9451
Mailing address:
  • Phone: 919-846-9142
  • Fax: 919-846-9451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2675
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1427
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC000391
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number008
License Number StateNC

VIII. Authorized Official

Name: MR. ARMAND E OCCHETTI
Title or Position: OWNER
Credential: LCSW
Phone: 919-846-9142