Provider Demographics
NPI:1770803272
Name:AGAPE PSYCHOLOGICAL
Entity type:Organization
Organization Name:AGAPE PSYCHOLOGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:FRANKLYN
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:336-855-4649
Mailing Address - Street 1:2211 W MEADOWVIEW RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-3409
Mailing Address - Country:US
Mailing Address - Phone:336-855-4649
Mailing Address - Fax:336-855-4645
Practice Address - Street 1:2211 W MEADOWVIEW RD
Practice Address - Street 2:SUITE 114
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3409
Practice Address - Country:US
Practice Address - Phone:336-855-4649
Practice Address - Fax:336-855-4645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002180133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty