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General NPI Number Information
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NPI Number | 1396804340
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Entity Type | Organization
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Legal Business Name | FOUR COUNTY PSYCHOLOGICAL ASSOCIATES, PA
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 568 RUIN CREEK RD JENKINS BLDG. SUITE 004
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City | HENDERSON
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State | NC
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Zip | 27536-2880
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Country | US
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Telephone | 252-430-1639
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Fax |
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Provider Business Mailing Address
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Address Line | 568 RUIN CREEK RD JENKINS BLDG. SUITE 004
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City | HENDERSON
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State | NC
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Zip | 27536-2880
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Country | US
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Telephone | 252-430-1639
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHANIE WILLIS HOYT
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Credential | PH.D.
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Telephone | 252-430-1639
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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 | 2590
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License Number State | NC
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