Provider Demographics
NPI:1558427856
Name:LARTER, WILLIAM MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:LARTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 LACY ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5341
Mailing Address - Country:US
Mailing Address - Phone:336-228-0112
Mailing Address - Fax:336-228-6994
Practice Address - Street 1:2224 LACY ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5341
Practice Address - Country:US
Practice Address - Phone:336-228-0112
Practice Address - Fax:336-228-6994
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1500103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000526Medicaid
NC6000526Medicaid
NCR59623Medicare UPIN