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General NPI Number Information
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NPI Number | 1912234915
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Entity Type | Organization
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Legal Business Name | FAIRVIEW PSYCHOLOGICAL SERVICES, P.A.
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Dates
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Enumeration Date | 11/11/2009
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Last Update Date | 11/11/2009
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Provider Practice Location Address
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Address Line | 1515 MOCKINGBIRD LN SUITE 215
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City | CHARLOTTE
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State | NC
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Zip | 28209-3236
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Country | US
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Telephone | 704-362-2618
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Fax |
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Provider Business Mailing Address
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Address Line | 691 HANOVER DR NW
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City | CONCORD
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State | NC
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Zip | 28027-7826
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Country | US
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Telephone | 704-362-2618
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/PRESIDENT
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Name | PATRICIA POWELL HUNDLEY
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Credential | M.A.
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Telephone | 704-362-2618
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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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