Provider Demographics
NPI:1629001953
Name:WAYNE M. SOTILE, PH.D.
Entity Type:Organization
Organization Name:WAYNE M. SOTILE, PH.D.
Other - Org Name:SOTILE PSYCHOLOGICAL ASSOCIATES, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SOTILE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:336-765-3032
Mailing Address - Street 1:1396 OLD MILL CIR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2976
Mailing Address - Country:US
Mailing Address - Phone:336-765-3032
Mailing Address - Fax:336-760-6977
Practice Address - Street 1:1396 OLD MILL CIR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2976
Practice Address - Country:US
Practice Address - Phone:336-765-3032
Practice Address - Fax:336-760-6977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1421Medicare ID - Type Unspecified