Provider Demographics
NPI:1629260682
Name:RICHARD MCCLINTOCK ET AL PTR ALBEMARLE COUNSELING GROUP
Entity Type:Organization
Organization Name:RICHARD MCCLINTOCK ET AL PTR ALBEMARLE COUNSELING GROUP
Other - Org Name:ALBEMARLE COUNSELING GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCLINTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:252-335-2018
Mailing Address - Street 1:1141 N ROAD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3354
Mailing Address - Country:US
Mailing Address - Phone:252-335-2018
Mailing Address - Fax:252-335-9521
Practice Address - Street 1:1141 N ROAD ST
Practice Address - Street 2:SUITE B
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3354
Practice Address - Country:US
Practice Address - Phone:252-335-2018
Practice Address - Fax:252-335-9521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000047Medicaid
NC6000047Medicaid