Provider Demographics
NPI:1689098774
Name:PSYCHOLOGICAL MOBILE SERVICES
Entity Type:Organization
Organization Name:PSYCHOLOGICAL MOBILE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNANT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:919-252-8896
Mailing Address - Street 1:779 TRUE VINE RD NE
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27863-8800
Mailing Address - Country:US
Mailing Address - Phone:919-252-4816
Mailing Address - Fax:
Practice Address - Street 1:105 S ELLINGTON ST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-2305
Practice Address - Country:US
Practice Address - Phone:252-291-0735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3681103T00000X
NC0389251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6008852Medicaid