Organization
SRRC PSYCHOLOGY
Active
Other names
SRRC Psychology
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH B FISER (VP MANAGED CARE AND REVENUE CYCLE)
(910) 615-5572
Entity
Organization
Contact information
Practice address
1638 OWEN DR, FAYETTEVILLE, NC 28304-3424
(910) 609-6440
(910) 609-5365
Mailing address
PO BOX 40908, FAYETTEVILLE, NC 28309-0908
(910) 609-6448
(910) 609-7040
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
H0213
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6005389
—
NC
Enumeration date
08/03/2005
Last updated
12/19/2023
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