Provider Demographics
NPI:1821861535
Name:OUTER BANKS PSYCHOLOGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:OUTER BANKS PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEENA
Authorized Official - Middle Name:BERRY
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:252-475-0378
Mailing Address - Street 1:PO BOX 1355
Mailing Address - Street 2:
Mailing Address - City:NAGS HEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27959
Mailing Address - Country:US
Mailing Address - Phone:252-216-2589
Mailing Address - Fax:
Practice Address - Street 1:110 W WOOD HILL DR
Practice Address - Street 2:
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959-9394
Practice Address - Country:US
Practice Address - Phone:252-216-2589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty