Provider Demographics
NPI:1952699456
Name:WALCOTT, CHRISTY MANGIONE (PHD)
Entity Type:Individual
Prefix:PROF
First Name:CHRISTY
Middle Name:MANGIONE
Last Name:WALCOTT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 RAWL BLDG, MAILSTOP 565
Mailing Address - Street 2:DEPARTMENT OF PSYCHOLOGY
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-4353
Mailing Address - Country:US
Mailing Address - Phone:252-328-1378
Mailing Address - Fax:
Practice Address - Street 1:104 RAWL BLDG, MAILSTOP 565
Practice Address - Street 2:DEPARTMENT OF PSYCHOLOGY
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-4353
Practice Address - Country:US
Practice Address - Phone:252-328-1378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4388103TS0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1752WOtherBCBSNC
NC6001394Medicaid
NCQ422220322Medicare PIN