Provider Demographics
NPI:1386849313
Name:UNCG PSYCHOLOGY CLINIC
Entity Type:Organization
Organization Name:UNCG PSYCHOLOGY CLINIC
Other - Org Name:AD/HD CLINIC AT UNCG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF AD/HD CLINIC AT UNCG
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:DAVIDE
Authorized Official - Last Name:ANASTOPAULOS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:336-346-3192
Mailing Address - Street 1:PO BOX 26170
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27402-6170
Mailing Address - Country:US
Mailing Address - Phone:336-346-3192
Mailing Address - Fax:336-346-3197
Practice Address - Street 1:200 E. NORTHWOOD ST.,
Practice Address - Street 2:SUITE 320
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401
Practice Address - Country:US
Practice Address - Phone:336-346-3192
Practice Address - Fax:336-346-3197
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF NORTH CAROLINA - GREENSBORO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-19
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903678Medicaid
NC6005278Medicaid