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General NPI Number Information
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NPI Number | 1952939811
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Entity Type | Organization
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Legal Business Name | A4PSYCHOLOGY, PLLC
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Dates
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Enumeration Date | 03/27/2020
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Last Update Date | 03/27/2020
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Provider Practice Location Address
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Address Line | 596 EXECUTIVE PL STE 201
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City | FAYETTEVILLE
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State | NC
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Zip | 28305-5189
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Country | US
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Telephone | 910-491-8545
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Fax | 910-491-0069
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Provider Business Mailing Address
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Address Line | 596 EXECUTIVE PL STE 201
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City | FAYETTEVILLE
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State | NC
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Zip | 28305-5189
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Country | US
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Telephone | 910-491-8545
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Fax | 910-491-0069
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Authorized Official
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Title or Position | MANAGING OWNER
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Name | DR. GEERTINA A ELLIS
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Credential | ED.D.,
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Telephone | 910-578-3451
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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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