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General NPI Number Information
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NPI Number | 1104928076
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Entity Type | Individual
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Provider Name | WAYNE M KIRSCHBAUM PH D
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Gender | Male
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 08/09/2010
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Provider Practice Location Address
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Address Line | 3534 HIGHVIEW RD
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City | CHARLOTTE
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State | NC
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Zip | 28210-6404
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Country | US
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Telephone | 704-553-1353
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Fax |
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Provider Business Mailing Address
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Address Line | 3534 HIGHVIEW RD
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City | CHARLOTTE
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State | NC
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Zip | 28210-6404
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Country | US
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Telephone | 704-553-1353
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0640
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License Number State | NC
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