Provider Demographics
NPI:1114297041
Name:SCN PSYHOLOGICAL AND CONSULTING SERVICES LLC
Entity Type:Organization
Organization Name:SCN PSYHOLOGICAL AND CONSULTING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BONDY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:704-442-9111
Mailing Address - Street 1:6729 FAIRVIEW RD STE D
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-0127
Mailing Address - Country:US
Mailing Address - Phone:704-442-9111
Mailing Address - Fax:
Practice Address - Street 1:6729 FAIRVIEW RD STE D
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-0127
Practice Address - Country:US
Practice Address - Phone:704-442-9111
Practice Address - Fax:704-442-0021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0271261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0271OtherLICENSE