Provider Demographics
NPI:1497098420
Name:NEUROPSYCHIATRIC CARE CENTER, PLLC
Entity Type:Organization
Organization Name:NEUROPSYCHIATRIC CARE CENTER, PLLC
Other - Org Name:NCC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MOJEED
Authorized Official - Middle Name:A
Authorized Official - Last Name:AKINTAYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-312-5764
Mailing Address - Street 1:445 DOLLEY MADISON RD STE 210
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-5169
Mailing Address - Country:US
Mailing Address - Phone:516-312-5764
Mailing Address - Fax:
Practice Address - Street 1:445 DOLLEY MADISON RD STE 210
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-5169
Practice Address - Country:US
Practice Address - Phone:516-312-5764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2023-11-08
Deactivation Date:2023-10-23
Deactivation Code:
Reactivation Date:2023-11-08
Provider Licenses
StateLicense IDTaxonomies
NC2009-005492084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911431Medicaid
NC5911431Medicaid