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General NPI Number Information
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NPI Number | 1588857619
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Entity Type | Organization
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Legal Business Name | ALBEMARLE PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 10/21/2011
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Provider Practice Location Address
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Address Line | 301 E CHURCH STREET
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City | ELIZABETH CITY
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State | NC
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Zip | 27909
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Country | US
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Telephone | 252-338-8821
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Fax | 252-338-6459
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Provider Business Mailing Address
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Address Line | PO BOX 303
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City | ELIZABETH CITY
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State | NC
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Zip | 27907
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Country | US
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Telephone | 252-338-8821
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Fax | 252-338-6459
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Authorized Official
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Title or Position | PARTNER
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Name | MR. ROGER D ALLEN
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Credential | PHD
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Telephone | 252-338-8821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | NCHSP0956
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | NCHSP0954
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License Number State | NC
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