Provider Demographics
NPI:1881085264
Name:FAYETTEVILLE VA MEDICAL CENER
Entity type:Organization
Organization Name:FAYETTEVILLE VA MEDICAL CENER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YOSHIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:YAMAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:910-488-2120
Mailing Address - Street 1:1111 SHELL DR
Mailing Address - Street 2:APT 60
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-2050
Mailing Address - Country:US
Mailing Address - Phone:910-488-2120
Mailing Address - Fax:
Practice Address - Street 1:1111 SHELL DR
Practice Address - Street 2:APT 60
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-2050
Practice Address - Country:US
Practice Address - Phone:910-488-2120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VETERAN'S ADMISTRATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017236283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital