Organization
NOVA-INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACEY PRIDGEN (CFO)
(919) 734-8803
Entity
Organization
Contact information
Practice address
2002 SHACKLEFORD ROAD, KINSTON, NC 28504-8917
(252) 233-0491
(252) 233-0495
Mailing address
PO BOX 11147, GOLDSBORO, NC 27532-1147
(919) 734-8803
(919) 735-6825
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
0715
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8301625G
—
NC
Enumeration date
03/16/2010
Last updated
09/27/2024
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