Provider Demographics
NPI:1932257219
Name:PSYCHIATRIC CLINIC OF SOUTHERN PINES
Entity Type:Organization
Organization Name:PSYCHIATRIC CLINIC OF SOUTHERN PINES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-246-0567
Mailing Address - Street 1:180 PERRY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-7020
Mailing Address - Country:US
Mailing Address - Phone:910-246-0567
Mailing Address - Fax:910-246-0669
Practice Address - Street 1:180 PERRY DR
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-7020
Practice Address - Country:US
Practice Address - Phone:910-246-0567
Practice Address - Fax:910-246-0669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC237782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC017GEOtherBCBS
NC017GEOtherBCBS