MEDICARE: BAY AREA PSYCHOLOGY ASSOCIATES, PLLC

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	1041C0700X	Clinical Social Worker
2	103T00000X	Psychologist

General Provider Information

NPI Number	:	1629499819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY AREA PSYCHOLOGY ASSOCIATES, PLLC

Provider Business Mailing Address
First Line	:	2457 GUM BRANCH RD STE 800
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540-4008
Country	:	US
Telephone Number	:	910-238-2774
Fax Number	:	910-387-0757

Provider Business Practice Location Address
First Line	:	2457 GUM BRANCH RD STE 800
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540-4008
Country	:	US
Telephone Number	:	910-238-2774
Fax Number	:	910-387-0757

Authorized Official
Title or Position	:	ADMINISTRATIVE DIRECTOR
Name	:	ALLISON BROOKS
Credential	:
Telephone Number	:	910-581-5352

Provider Enumeration Date	:	12/14/2013
Last Update Date	:	06/16/2023

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