Provider Demographics
NPI:1417658576
Name:CAROLINA PSYCHOLOGICAL ASSESSMENT CENTER (CPAC)
Entity Type:Organization
Organization Name:CAROLINA PSYCHOLOGICAL ASSESSMENT CENTER (CPAC)
Other - Org Name:ROOTS PSYCHOLOGY, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:DURR
Authorized Official - Suffix:II
Authorized Official - Credentials:PHD
Authorized Official - Phone:828-412-3144
Mailing Address - Street 1:111 MCDOWELL ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4409
Mailing Address - Country:US
Mailing Address - Phone:828-412-3144
Mailing Address - Fax:828-782-3002
Practice Address - Street 1:111 MCDOWELL ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4409
Practice Address - Country:US
Practice Address - Phone:828-412-3144
Practice Address - Fax:828-782-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-15
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty