Healthcare Provider Details

I. General information

NPI: 1760891980
Provider Name (Legal Business Name): CAPESIDE PSYCHIATRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2014
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 JUDGES RD STE 4E
WILMINGTON NC
28405-3655
US

IV. Provider business mailing address

311 JUDGES RD STE 4E
WILMINGTON NC
28405-3655
US

V. Phone/Fax

Practice location:
  • Phone: 910-791-6767
  • Fax: 910-399-2190
Mailing address:
  • Phone: 910-791-6767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AMANDA DIXON
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 910-520-6756