Healthcare Provider Details

I. General information

NPI: 1639259112
Provider Name (Legal Business Name): OSVOLD PSYCHOTHERAPY & TESTING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 MCNEELY DR SUITE 101
RALEIGH NC
27612-7623
US

IV. Provider business mailing address

913 W SOUTH ST
RALEIGH NC
27603-2159
US

V. Phone/Fax

Practice location:
  • Phone: 919-787-1240
  • Fax: 919-787-1241
Mailing address:
  • Phone: 919-787-1240
  • Fax: 919-787-1241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2675
License Number StateNC

VIII. Authorized Official

Name: DR. LISE LEIGH OSVOLD
Title or Position: PRESIDENT
Credential: PH.D., L.P.
Phone: 919-787-1240