Provider Demographics
NPI:1497897300
Name:WARREN, BIRCHIE ST CLAIR JR (MA,LPA,HSP-PA)
Entity Type:Individual
Prefix:MR
First Name:BIRCHIE
Middle Name:ST CLAIR
Last Name:WARREN
Suffix:JR
Gender:M
Credentials:MA,LPA,HSP-PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 PINEHALL WYND
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-5986
Mailing Address - Country:US
Mailing Address - Phone:919-212-3630
Mailing Address - Fax:
Practice Address - Street 1:5300 PINEHALL WYND
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-5986
Practice Address - Country:US
Practice Address - Phone:919-212-3630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1357103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107400Medicaid
NC1357OtherNC PSYCHOLOGY LICENSE