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General NPI Number Information
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NPI Number | 1295791143
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Entity Type | Individual
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Provider Name | MARY SANDRA STORY PSY.D., P.C.
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Gender | Female
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 8512 SIX FORKS RD SUITE 102
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City | RALEIGH
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State | NC
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Zip | 27615-2962
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Country | US
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Telephone | 919-844-8711
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Fax | 919-844-8706
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Provider Business Mailing Address
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Address Line | 8512 SIX FORKS RD SUITE 102
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City | RALEIGH
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State | NC
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Zip | 27615-2962
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Country | US
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Telephone | 919-844-8711
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Fax | 919-844-8706
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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 | 2659
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License Number State | NC
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