Provider Demographics
NPI:1093884819
Name:CHILD & FAMILY PSYCHOLOGICAL CONSULTANTS, P.A.
Entity Type:Organization
Organization Name:CHILD & FAMILY PSYCHOLOGICAL CONSULTANTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:STRAG
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:252-633-0014
Mailing Address - Street 1:1425 S GLENBURNIE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2610
Mailing Address - Country:US
Mailing Address - Phone:252-633-0014
Mailing Address - Fax:252-633-3793
Practice Address - Street 1:1425 S GLENBURNIE RD STE 1
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2610
Practice Address - Country:US
Practice Address - Phone:252-633-0014
Practice Address - Fax:252-633-3793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0769103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6001903Medicaid
NC6001903Medicaid