Healthcare Provider Details

I. General information

NPI: 1871503631
Provider Name (Legal Business Name): GLENN NOEL PAULE-CARRES PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 10/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 AMHERST ST
WINCHESTER VA
22601-4114
US

IV. Provider business mailing address

PO BOX 82
WINCHESTER VA
22604-0082
US

V. Phone/Fax

Practice location:
  • Phone: 540-667-0461
  • Fax: 540-662-6334
Mailing address:
  • Phone: 540-667-0461
  • Fax: 540-662-6334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0810001007
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number0810001007
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number0810001007
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number0810001007
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810001007
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number0810001007
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number0810001007
License Number StateVA
# 8
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number0810001007
License Number StateVA
# 9
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number0810001007
License Number StateVA
# 10
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number0810001007
License Number StateVA
# 11
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0810001007
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: