Provider Demographics
NPI:1245895127
Name:CAROLINA PSYCHOLOGY CENTER, PLLC
Entity type:Organization
Organization Name:CAROLINA PSYCHOLOGY CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAYME
Authorized Official - Middle Name:
Authorized Official - Last Name:YODICE
Authorized Official - Suffix:
Authorized Official - Credentials:LPA
Authorized Official - Phone:704-609-3614
Mailing Address - Street 1:1905 J N PEASE PL STE 104
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4509
Mailing Address - Country:US
Mailing Address - Phone:704-609-3614
Mailing Address - Fax:980-225-0482
Practice Address - Street 1:1905 J N PEASE PL STE 104
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4509
Practice Address - Country:US
Practice Address - Phone:704-609-3614
Practice Address - Fax:980-225-0482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-06
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty