Individual
MISS MARY ENGELSTATTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1703 COUNTRY CLUB ROAD, SUITE 204, JACKSONVILLE, NC 28546
(910) 347-3010
(910) 347-3201
Mailing address
1703 COUNTRY CLUB ROAD, SUITE 204, JACKSONVILLE, NC 28546
(910) 347-3010
(910) 347-3201
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
2551
NC
103T00000X
Psychologist
Primary
4748
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
046UR
BC/BS
NC
Enumeration date
12/16/2005
Last updated
04/13/2022
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