Provider Demographics
NPI:1518245752
Name:NC PSYCHIATRIC ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:NC PSYCHIATRIC ASSOCIATES, PLLC
Other - Org Name:CAROLINA PSYCHIATRIC ASSOC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WRIGHT-ETTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-375-7579
Mailing Address - Street 1:3623 LATROBE DR
Mailing Address - Street 2:SUITE #121
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-4864
Mailing Address - Country:US
Mailing Address - Phone:704-375-7579
Mailing Address - Fax:
Practice Address - Street 1:3623 LATROBE DR
Practice Address - Street 2:SUITE #121
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-4864
Practice Address - Country:US
Practice Address - Phone:704-375-7579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC329172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC898944CMedicaid
SCN32917Medicaid
NC213251DMedicare PIN
NC898944CMedicaid
SCN32917Medicaid