MEDICARE: CARLIE BARBOUR PSY.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	1715	NC

General Provider Information

NPI Number	:	1073816294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLIE BARBOUR PSY.D

Provider Business Mailing Address
First Line	:	300 W BROADWAY ST
Second Line	:
City	:	PINK HILL
State	:	NC
Zip	:	28572-7986
Country	:	US
Telephone Number	:	252-268-0597
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 CRAPE MYRTLE DR
Second Line	:	SUITE 104
City	:	BENSON
State	:	NC
Zip	:	27504-8034
Country	:	US
Telephone Number	:	919-938-0875
Fax Number	:	919-934-0266

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2010
Last Update Date	:	06/18/2015

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