MEDICARE: AGAPE PSYCHOLOGICAL

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	133V00000X	Registered Dietitian	L002180	NC

General Provider Information

NPI Number	:	1770803272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAPE PSYCHOLOGICAL

Provider Business Mailing Address
First Line	:	2211 W MEADOWVIEW RD
Second Line	:	SUITE 114
City	:	GREENSBORO
State	:	NC
Zip	:	27407-3409
Country	:	US
Telephone Number	:	336-855-4649
Fax Number	:	336-855-4645

Provider Business Practice Location Address
First Line	:	2211 W MEADOWVIEW RD
Second Line	:	SUITE 114
City	:	GREENSBORO
State	:	NC
Zip	:	27407-3409
Country	:	US
Telephone Number	:	336-855-4649
Fax Number	:	336-855-4645

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. EDWARD FRANKLYN MORRIS
Credential	:	PHD
Telephone Number	:	336-855-4649

Provider Enumeration Date	:	06/07/2010
Last Update Date	:	06/07/2010

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