Organization
PSYCHOLOGICAL HEALTH SERVICES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY C NEMATI PH.D. (PRESIDENT)
(336) 297-1981
Entity
Organization
Contact information
Practice address
2100 FAIRFAX RD, SUITE 208, GREENSBORO, NC 27407-3009
(336) 297-1981
(336) 297-1983
Mailing address
2100 FAIRFAX RD, SUITE 208, GREENSBORO, NC 27407-3009
(336) 297-1981
(336) 297-1983
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2642
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
045HP
BCBS PROVIDER NUMBER
NC
05
—
1336191444
—
NC
05
—
6000189
—
NC
01
—
E3524
MEDCOST PROVIDER NUMBER
NC
Enumeration date
05/17/2006
Last updated
05/21/2010
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