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Organization

ELIZABETH A DEROUIN

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ELIZABETH ALEXANDRIA DEROUIN PHD (CLINICAL PSYCHOLOGIST)
(910) 494-6000
Entity
Organization

Contact information

Practice address
422 W 9TH ST, NEWTON, NC 28658-3819
(910) 494-6000
Mailing address
422 W 9TH ST, NEWTON, NC 28658-3819
(910) 494-6000

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
103TA0700X
Adult Development & Aging Psychologist
103TB0200X
Cognitive & Behavioral Psychologist
103TC0700X
Clinical Psychologist
103TC2200X
Clinical Child & Adolescent Psychologist
103TF0200X
Forensic Psychologist

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1275004111
NC
Enumeration date
05/05/2020
Last updated
12/02/2020
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