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General NPI Number Information
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NPI Number | 1093049199
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Entity Type | Individual
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Provider Name | WILLIAM RICHARD MATHIS MA
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Gender | Male
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Dates
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Enumeration Date | 09/23/2009
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Last Update Date | 12/17/2009
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Provider Practice Location Address
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Address Line | 171 COMTECH DR
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City | PEMBROKE
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State | NC
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Zip | 28372-7270
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Country | US
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Telephone | 910-736-3351
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Fax |
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Provider Business Mailing Address
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Address Line | 402 PINELAKE PARK RD
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City | PEMBROKE
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State | NC
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Zip | 28372-9212
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Country | US
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Telephone | 910-258-7796
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 0537
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 0537
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 0537
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 537
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License Number State | NC
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Taxonomy #5
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number | 0537
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License Number State | NC
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