Provider Demographics
NPI:1598901159
Name:WALYKO PSYCHOLOGICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:WALYKO PSYCHOLOGICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGICAL ASSOCIATE
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:REEVES
Authorized Official - Last Name:WALYKO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:252-937-7661
Mailing Address - Street 1:220 EMERSON DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27803-2234
Mailing Address - Country:US
Mailing Address - Phone:252-937-7661
Mailing Address - Fax:252-353-6511
Practice Address - Street 1:3485 S EVANS ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4532
Practice Address - Country:US
Practice Address - Phone:252-353-6277
Practice Address - Fax:252-353-6511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1699261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC04579OtherBLUE CROSS BLUE SHIELD
NCE4385OtherMEDCOST
NC6107008Medicaid