Individual
WILLIAM RICHARD MATHIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
171 COMTECH DR, PEMBROKE, NC 28372-7270
(910) 736-3351
Mailing address
402 PINELAKE PARK RD, PEMBROKE, NC 28372-9212
(910) 258-7796
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
0537
NC
103K00000X
Behavior Analyst
0537
NC
103T00000X
Psychologist
Primary
0537
NC
103TC2200X
Clinical Child & Adolescent Psychologist
537
NC
103TM1800X
Intellectual & Developmental Disabilities Psychologist
0537
NC
Other
Enumeration date
09/23/2009
Last updated
12/17/2009
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