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General NPI Number Information
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NPI Number | 1952301079
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 07/29/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 302 N MAIN ST
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City | FAIRMONT
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State | NC
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Zip | 28340-1730
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Country | US
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Telephone | 910-628-6718
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Fax | 910-628-6719
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Provider Business Mailing Address
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Address Line | 302 N MAIN ST PO BOX 369
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City | FAIRMONT
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State | NC
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Zip | 28340-1730
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Country | US
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Telephone | 910-628-6718
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Fax | 910-628-6719
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | MS. LINDA OLIVER-LINK
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Credential |
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Telephone | 910-682-6718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | NC
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