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General NPI Number Information
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NPI Number | 1043414980
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Entity Type | Organization
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Legal Business Name | THE CLINICAL EVALUATION AND RESOURCE CENTER, PLLC
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 943 W ANDREWS AVE STE P
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City | HENDERSON
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State | NC
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Zip | 27536-2587
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Country | US
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Telephone | 252-430-1255
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Fax |
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Provider Business Mailing Address
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Address Line | 943 W ANDREWS AVE STE P
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City | HENDERSON
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State | NC
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Zip | 27536-2587
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Country | US
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Telephone | 252-430-1255
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. CAMILLA E. ROGERS
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Credential | LPA
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Telephone | 252-430-1255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1956
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License Number State | NC
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