Provider Demographics
NPI:1861672552
Name:ALBEMARLE PSYCHOLOGICAL INNOVATIONS, PLLC
Entity Type:Organization
Organization Name:ALBEMARLE PSYCHOLOGICAL INNOVATIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:KLEINSCHUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:252-338-0098
Mailing Address - Street 1:400 S WATER ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-4965
Mailing Address - Country:US
Mailing Address - Phone:252-338-0098
Mailing Address - Fax:
Practice Address - Street 1:400 S WATER ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4965
Practice Address - Country:US
Practice Address - Phone:252-338-0098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3186103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty