=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114151990
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAPIA PSYCHOLOGICAL ASSOCIATES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2009
-----------------------------------------------------
Last Update Date | 04/05/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4320 SOUTHPORT SUPPLY RD SE SUITE 200
-----------------------------------------------------
City | SOUTHPORT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28461-8158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-457-0800
-----------------------------------------------------
Fax | 910-457-1072
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4320 SOUTHPORT SUPPLY RD SE SUITE 200
-----------------------------------------------------
City | SOUTHPORT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28461-8158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-457-0800
-----------------------------------------------------
Fax | 910-457-1072
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JENNIFER L SAPIA
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 910-457-0800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 0398
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------