Provider Demographics
NPI:1376702084
Name:FALLS NEUROPSYCHOLOGY AND PSYCHOTHERAPY ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:FALLS NEUROPSYCHOLOGY AND PSYCHOTHERAPY ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:QUIRK
Authorized Official - Last Name:BUNDICK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-870-0264
Mailing Address - Street 1:8216 CREEDMOOR RD STE 101
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1391
Mailing Address - Country:US
Mailing Address - Phone:919-870-0264
Mailing Address - Fax:866-777-4638
Practice Address - Street 1:8216 CREEDMOOR RD STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-1391
Practice Address - Country:US
Practice Address - Phone:919-870-0264
Practice Address - Fax:919-870-0293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3043103TC0700X
NCC0047841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty