Provider Demographics
NPI:1619199395
Name:UNC DEPARTMENT OF PSYCHOLOGY COMMUNITY CLINIC
Entity Type:Organization
Organization Name:UNC DEPARTMENT OF PSYCHOLOGY COMMUNITY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:HELENE
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-962-5034
Mailing Address - Street 1:UNC DEPARTMENT OF PSYCHOLOGY COMMUNITY CLINIC
Mailing Address - Street 2:CB# 3270 UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-3270
Mailing Address - Country:US
Mailing Address - Phone:919-962-5034
Mailing Address - Fax:
Practice Address - Street 1:UNC DEPARTMENT OF PSYCHOLOGY COMMUNITY CLINIC
Practice Address - Street 2:CB# 3270 UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-3270
Practice Address - Country:US
Practice Address - Phone:919-962-5034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty