Provider Demographics
NPI:1912234915
Name:FAIRVIEW PSYCHOLOGICAL SERVICES, P.A.
Entity Type:Organization
Organization Name:FAIRVIEW PSYCHOLOGICAL SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:POWELL
Authorized Official - Last Name:HUNDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:704-362-2618
Mailing Address - Street 1:691 HANOVER DR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-7826
Mailing Address - Country:US
Mailing Address - Phone:704-362-2618
Mailing Address - Fax:
Practice Address - Street 1:1515 MOCKINGBIRD LN
Practice Address - Street 2:SUITE 215
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3236
Practice Address - Country:US
Practice Address - Phone:704-362-2618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty