Organization
NORTH CAROLINA NEUROPSYCHIATRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY CLARK (ADMINISTRATOR)
(919) 785-5055
Entity
Organization
Contact information
Practice address
6911 SHANNON WILLOW RD STE 400, CHARLOTTE, NC 28226-1350
(980) 296-2211
(984) 235-1617
Mailing address
6911 SHANNON WILLOW RD STE 400, CHARLOTTE, NC 28226-1350
(980) 296-2211
(984) 235-1617
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
—
—
103T00000X
Psychologist
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
230737
MEDICARE PTAN
NC
Enumeration date
09/07/2010
Last updated
02/23/2023
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