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General NPI Number Information
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NPI Number | 1245895127
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Entity Type | Organization
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Legal Business Name | CAROLINA PSYCHOLOGY CENTER, PLLC
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Dates
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Enumeration Date | 05/06/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 1905 J N PEASE PL STE 104
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City | CHARLOTTE
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State | NC
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Zip | 28262-4509
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Country | US
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Telephone | 704-609-3614
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Fax | 980-225-0482
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Provider Business Mailing Address
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Address Line | 1905 J N PEASE PL STE 104
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City | CHARLOTTE
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State | NC
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Zip | 28262-4509
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Country | US
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Telephone | 704-609-3614
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Fax | 980-225-0482
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Authorized Official
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Title or Position | OWNER
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Name | JAYME YODICE
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Credential | LPA
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Telephone | 704-609-3614
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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 |
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License Number State |
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