Provider Demographics
NPI:1528191533
Name:RAINEY, JAMMIE NOEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMMIE
Middle Name:NOEL
Last Name:RAINEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7310 MIDDLEBURY PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-4721
Mailing Address - Country:US
Mailing Address - Phone:704-532-8438
Mailing Address - Fax:
Practice Address - Street 1:800 BRIAR CREEK ROAD
Practice Address - Street 2:SUITE BB-400 THE PARK EXPO & CONFERENCE CENTER
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6903
Practice Address - Country:US
Practice Address - Phone:704-408-3703
Practice Address - Fax:704-537-9356
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2514103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCD1402OtherMEDCOST PROVIDER #
NC6000469Medicaid
NC045JGOtherBCBS
NC6000469Medicaid