Provider Demographics
NPI:1437243086
Name:KLEINSCHUSTER, DAVID WESLEY (PSY D, MED, MA)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WESLEY
Last Name:KLEINSCHUSTER
Suffix:
Gender:M
Credentials:PSY D, MED, MA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:400 S WATER ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-4965
Mailing Address - Country:US
Mailing Address - Phone:252-338-0098
Mailing Address - Fax:252-335-1493
Practice Address - Street 1:400 S WATER ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4965
Practice Address - Country:US
Practice Address - Phone:252-338-0098
Practice Address - Fax:252-335-1493
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC3186103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC046WCOtherBC/BS
NC6000844Medicaid
NC6000844Medicaid