Provider Demographics
NPI:1225103237
Name:THE CAROLINA PSYCHOLOGICAL GROUP, P.A.
Entity Type:Organization
Organization Name:THE CAROLINA PSYCHOLOGICAL GROUP, P.A.
Other - Org Name:CAROLINA CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:252-757-0123
Mailing Address - Street 1:702 JOHNS HOPKINS DRIVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7220
Mailing Address - Country:US
Mailing Address - Phone:252-757-0123
Mailing Address - Fax:252-757-3461
Practice Address - Street 1:702 JOHNS HOPKINS DRIVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7220
Practice Address - Country:US
Practice Address - Phone:252-757-0123
Practice Address - Fax:252-757-3461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL074-31101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0103TOtherBLUE CROSS & BLUE SHIELD
NC2801145AMedicare ID - Type Unspecified