Provider Demographics
NPI:1467409003
Name:CAROLINA PSYCHOLOGICAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:CAROLINA PSYCHOLOGICAL ASSOCIATES, P.A.
Other - Org Name:CAROLINA PSYCHOLOGICAL ASSOCIATES, P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-272-0855
Mailing Address - Street 1:1501 HIGHWOODS BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410
Mailing Address - Country:US
Mailing Address - Phone:210-881-0890
Mailing Address - Fax:210-569-6464
Practice Address - Street 1:1501 HIGHWOODS BLVD
Practice Address - Street 2:STE 101
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410
Practice Address - Country:US
Practice Address - Phone:336-272-0855
Practice Address - Fax:336-272-9885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0067103TC0700X, 103TC1900X, 1041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1595Medicare ID - Type UnspecifiedMEDICARE GROUP ID