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General NPI Number Information
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NPI Number | 1558483743
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Entity Type | Organization
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Legal Business Name | THE NORDAL CLINIC, PA
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1121 GROVE ST
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City | VICKSBURG
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State | MS
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Zip | 39183-2913
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Country | US
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Telephone | 601-634-0118
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Fax | 601-630-0302
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Provider Business Mailing Address
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Address Line | 1121 GROVE ST
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City | VICKSBURG
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State | MS
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Zip | 39183-2913
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Country | US
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Telephone | 601-634-0118
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Fax | 601-630-0302
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KATHERINE C NORDAL
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Credential | PH.D.
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Telephone | 601-634-0118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number |
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License Number State | MS
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