Provider Demographics
NPI:1205216181
Name:PSYCHOLOGICAL SERVICES OF CINDY C. COTTLE, PLLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL SERVICES OF CINDY C. COTTLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:C
Authorized Official - Last Name:COTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-301-8513
Mailing Address - Street 1:4505 FAIR MEADOWS LN
Mailing Address - Street 2:STE 106
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6465
Mailing Address - Country:US
Mailing Address - Phone:919-301-8513
Mailing Address - Fax:919-882-1685
Practice Address - Street 1:4505 FAIR MEADOWS LN
Practice Address - Street 2:STE 106
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6465
Practice Address - Country:US
Practice Address - Phone:919-301-8513
Practice Address - Fax:919-882-1685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3061103T00000X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Single Specialty