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General NPI Number Information
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NPI Number | 1619328077
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Entity Type | Organization
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Legal Business Name | NORTH FOURTH COUNSELING AND PSYCOLOGICAL SERVICES GROUP, PLLC
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Dates
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Enumeration Date | 06/28/2016
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Last Update Date | 06/28/2016
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Provider Practice Location Address
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Address Line | 2018 FORT BRAGG RD SUITE 110
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-7037
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Country | US
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Telephone | 910-273-0265
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Fax | 910-483-3400
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Provider Business Mailing Address
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Address Line | 2018 FT. BRAGG ROAD SUITE 110
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-7037
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Country | US
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Telephone | 910-273-0265
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Fax | 910-483-3400
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Authorized Official
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Title or Position | CO-OWNER
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Name | RONALD RAY JOHNSON JR.
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Credential | PSYD
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Telephone | 910-273-0265
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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 | 3148
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License Number State | NC
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