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General NPI Number Information
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NPI Number | 1255571410
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Entity Type | Organization
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Legal Business Name | PAIN MANAGEMENT PSYCHOLOGY SERVICES, PA
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Dates
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Enumeration Date | 03/02/2009
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Last Update Date | 10/18/2013
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Provider Practice Location Address
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Address Line | 160 KIMEL FOREST DR. STE. 100
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City | WINSTON-SALEM
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State | NC
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Zip | 27103-6084
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Country | US
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Telephone | 336-770-6451
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Fax | 336-714-6475
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Provider Business Mailing Address
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Address Line | 160 KIMEL FOREST DR. STE. 100
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City | WINSTON-SALEM
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State | NC
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Zip | 27103-6084
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Country | US
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Telephone | 336-770-6451
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Fax | 336-714-6475
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIMOTHY NORRIS WEBSTER
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Credential | PH.D.
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Telephone | 336-770-6451
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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 | 0388
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License Number State | NC
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