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General NPI Number Information
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NPI Number | 1689563967
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Entity Type | Organization
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Legal Business Name | CAROLINA INTEGRATIVE PSYCHOLOGICAL SERVICES, PLLC
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Dates
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Enumeration Date | 07/01/2025
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 16 OWL LN
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City | NEWLAND
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State | NC
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Zip | 28657
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Country | US
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Telephone | 919-815-1370
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Fax |
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Provider Business Mailing Address
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Address Line | 2002 LAND HBR
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City | NEWLAND
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State | NC
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Zip | 28657-7923
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | LUISA JIMENEZ-RUBLE
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Credential | PSYD
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Telephone | 919-815-1370
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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 |
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License Number State |
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