Organization
PSYCHOLOGY SOUTH, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CORINNE SECREST PH.D. (OWNER)
(704) 608-2142
Entity
Organization
Contact information
Practice address
4 SOURWOOD DR, MILLS RIVER, NC 28759-1960
(704) 608-2142
Mailing address
4 SOURWOOD DR, MILLS RIVER, NC 28759-1960
(704) 608-2142
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1710120738
PSYCHOLOGIST
NC
Enumeration date
06/27/2023
Last updated
06/27/2023
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