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General NPI Number Information
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NPI Number | 1114297041
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Entity Type | Organization
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Legal Business Name | SCN PSYHOLOGICAL AND CONSULTING SERVICES LLC
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Dates
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Enumeration Date | 01/10/2012
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Last Update Date | 01/10/2012
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Provider Practice Location Address
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Address Line | 6729 FAIRVIEW RD STE D
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City | CHARLOTTE
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State | NC
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Zip | 28210-0127
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Country | US
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Telephone | 704-442-9111
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Fax | 704-442-0021
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Provider Business Mailing Address
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Address Line | 6729 FAIRVIEW RD STE D
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City | CHARLOTTE
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State | NC
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Zip | 28210-0127
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Country | US
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Telephone | 704-442-9111
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. STEPHEN B. BONDY
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Credential | PH.D
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Telephone | 704-442-9111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 0271
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License Number State | NC
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