Provider Demographics
NPI:1386689966
Name:LOLLI, PETER P (PHD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:P
Last Name:LOLLI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 PINEDALE RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-4706
Mailing Address - Country:US
Mailing Address - Phone:336-282-0052
Mailing Address - Fax:336-282-5845
Practice Address - Street 1:2711 PINEDALE RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-4706
Practice Address - Country:US
Practice Address - Phone:336-282-0052
Practice Address - Fax:336-282-5845
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1062103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent