Provider Demographics
NPI:1992021752
Name:MCNALLY PSYCHOLOGICAL CONSULTANTS, INCORPORATED
Entity Type:Organization
Organization Name:MCNALLY PSYCHOLOGICAL CONSULTANTS, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MCNALLY
Authorized Official - Suffix:
Authorized Official - Credentials:LPA
Authorized Official - Phone:919-880-6575
Mailing Address - Street 1:2320 AVINSHIRE PL
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-5375
Mailing Address - Country:US
Mailing Address - Phone:919-880-6575
Mailing Address - Fax:919-556-7219
Practice Address - Street 1:2320 AVINSHIRE PL
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-5375
Practice Address - Country:US
Practice Address - Phone:919-880-6575
Practice Address - Fax:919-556-7219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2107103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107057Medicaid