Provider Demographics
NPI:1982117669
Name:SOUND PSYCHOLOGIAL SERVICES, PA
Entity Type:Organization
Organization Name:SOUND PSYCHOLOGIAL SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:MILLER-URBAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPA
Authorized Official - Phone:910-538-5334
Mailing Address - Street 1:100 N GADWALL CT
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-7159
Mailing Address - Country:US
Mailing Address - Phone:910-538-5334
Mailing Address - Fax:
Practice Address - Street 1:3317 MASONBORO LOOP RD UNIT 160
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28409-2970
Practice Address - Country:US
Practice Address - Phone:910-538-5334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1633640261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)