Provider Demographics
NPI:1659797686
Name:MOSAIC PSYCHOLOGICAL CENTER, PLLC
Entity Type:Organization
Organization Name:MOSAIC PSYCHOLOGICAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVARRO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:704-774-0459
Mailing Address - Street 1:425 S SHARON AMITY RD STE D
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2841
Mailing Address - Country:US
Mailing Address - Phone:704-774-0459
Mailing Address - Fax:704-910-0071
Practice Address - Street 1:425 S SHARON AMITY RD STE D
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2841
Practice Address - Country:US
Practice Address - Phone:704-774-0459
Practice Address - Fax:704-910-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-14
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3736103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6001157Medicaid
NC6001157Medicaid