Organization
THE NEUROPSYCHOLOGY CONSULTANTS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELWOOD JOHNSON BURGESS JR. PSY.D. (PRESIDENT)
(919) 785-9944
Entity
Organization
Contact information
Practice address
3824 BARRETT DR, SUITE 101, RALEIGH, NC 27609-7220
(919) 785-9944
(919) 785-9992
Mailing address
3824 BARRETT DR, SUITE 101, RALEIGH, NC 27609-7220
(919) 785-9944
(919) 785-9992
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
2249
NC
103T00000X
Psychologist
2249
NC
103TC0700X
Clinical Psychologist
Primary
2249
NC
103TC2200X
Clinical Child & Adolescent Psychologist
2249
NC
103TF0200X
Forensic Psychologist
2249
NC
103TR0400X
Rehabilitation Psychologist
2249
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
027YM
BCBS
NC
05
—
6005171
—
NC
Enumeration date
08/05/2007
Last updated
09/10/2013
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