Healthcare Provider Details

I. General information

NPI: 1801984646
Provider Name (Legal Business Name): EVANS EMMETT HARRELL PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

852 COUNTRY CLUB ROAD
ROCKY MOUNT NC
27804
US

IV. Provider business mailing address

852 COUNTRY CLUB ROAD
ROCKY MOUNT NC
27804
US

V. Phone/Fax

Practice location:
  • Phone: 252-443-4401
  • Fax: 252-972-4502
Mailing address:
  • Phone: 252-443-4401
  • Fax: 252-972-4502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0622
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0622
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: