Provider Demographics
NPI:1144747452
Name:PRISM PSYCHOLOGICAL SERVICES, PC
Entity Type:Organization
Organization Name:PRISM PSYCHOLOGICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:704-212-2020
Mailing Address - Street 1:19810 W CATAWBA AVE STE E
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-4057
Mailing Address - Country:US
Mailing Address - Phone:704-212-2020
Mailing Address - Fax:704-212-2020
Practice Address - Street 1:19810 W CATAWBA AVE STE E
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-4057
Practice Address - Country:US
Practice Address - Phone:704-212-2020
Practice Address - Fax:704-212-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4903103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty