Provider Demographics
NPI:1376779116
Name:MCDERMOTT, ADAM THOMAS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:THOMAS
Last Name:MCDERMOTT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 WESTCHESTER DR
Mailing Address - Street 2:STE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7254
Mailing Address - Country:US
Mailing Address - Phone:336-802-2400
Mailing Address - Fax:336-802-2534
Practice Address - Street 1:1814 WESTCHESTER DR
Practice Address - Street 2:STE 402
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-7359
Practice Address - Country:US
Practice Address - Phone:336-802-2205
Practice Address - Fax:336-802-2206
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4122103G00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6001286Medicaid
NCMCQ36458AMedicare PIN