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General NPI Number Information
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NPI Number | 1336191444
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL HEALTH SERVICES, PC
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 05/21/2010
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Provider Practice Location Address
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Address Line | 2100 FAIRFAX RD SUITE 208
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City | GREENSBORO
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State | NC
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Zip | 27407-3009
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Country | US
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Telephone | 336-297-1981
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Fax | 336-297-1983
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Provider Business Mailing Address
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Address Line | 2100 FAIRFAX RD SUITE 208
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City | GREENSBORO
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State | NC
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Zip | 27407-3009
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Country | US
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Telephone | 336-297-1981
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Fax | 336-297-1983
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARY C NEMATI
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Credential | PH.D.
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Telephone | 336-297-1981
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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 | 2642
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License Number State | NC
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