Provider Demographics
NPI:1609229178
Name:CAROLINA CHILD PSYCHOLOGY, PLLC
Entity Type:Organization
Organization Name:CAROLINA CHILD PSYCHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-791-7978
Mailing Address - Street 1:PO BOX 174
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:NC
Mailing Address - Zip Code:27342-0174
Mailing Address - Country:US
Mailing Address - Phone:919-791-7978
Mailing Address - Fax:
Practice Address - Street 1:24 NW COURT SQ
Practice Address - Street 2:STE 302
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-2860
Practice Address - Country:US
Practice Address - Phone:919-791-7978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3597103T00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty