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General NPI Number Information
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NPI Number | 1730131863
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Entity Type | Organization
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Legal Business Name | CAROLINA PSYCH GROUP, PA
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 515 BROOKDALE DR
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City | STATESVILLE
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State | NC
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Zip | 28677-4107
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Country | US
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Telephone | 704-873-1697
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Fax |
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Provider Business Mailing Address
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Address Line | 515 BROOKDALE DR
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City | STATESVILLE
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State | NC
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Zip | 28677-4107
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Country | US
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Telephone | 704-873-1697
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Fax |
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Authorized Official
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Title or Position | CEO/CLINICAL PSYCHOLOGIST
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Name | DR. JAMES A POWELL
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Credential | PSY.D.
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Telephone | 704-873-1697
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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 | 633
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License Number State | NC
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