Organization
SOUTHEAST PSYCHOLOGICAL SERVICES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANET H IYOOB (CFO)
(704) 552-0116
Entity
Organization
Contact information
Practice address
8840 BLAKENEY PROFESSIONAL DR, SUITE 200, CHARLOTTE, NC 28277-6718
(704) 552-0116
(704) 552-7550
Mailing address
6115 PARK SOUTH DR, SUITE 130, CHARLOTTE, NC 28210-3269
(704) 552-0116
(704) 552-7550
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
5021
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6005111
—
NC
Enumeration date
04/30/2009
Last updated
04/30/2009
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