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General NPI Number Information
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NPI Number | 1376815613
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Entity Type | Organization
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Legal Business Name | GERIPSYCH SERVICES PLLC
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Dates
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Enumeration Date | 02/02/2012
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Last Update Date | 06/24/2015
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Provider Practice Location Address
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Address Line | 611 OLD US HWY 70 E
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City | BLACK MOUNTAIN
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State | NC
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Zip | 28711-9488
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Country | US
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Telephone | 828-665-7062
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 263
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City | CANDLER
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State | NC
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Zip | 28715-0263
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Country | US
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Telephone | 828-665-7062
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. GINA M HAGAR
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Credential | PSYCHOLOGIST
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Telephone | 828-665-7062
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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 | 3730
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License Number State | NC
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