Provider Demographics
NPI:1124210034
Name:RALEIGH PSYCHOLOGY AND COUNSELING, PA
Entity type:Organization
Organization Name:RALEIGH PSYCHOLOGY AND COUNSELING, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:FLANNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD PSYCHOLOGIST
Authorized Official - Phone:919-845-7445
Mailing Address - Street 1:8524 SIX FORKS RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3099
Mailing Address - Country:US
Mailing Address - Phone:919-845-7445
Mailing Address - Fax:919-845-7443
Practice Address - Street 1:8524 SIX FORKS RD
Practice Address - Street 2:SUITE 203
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3099
Practice Address - Country:US
Practice Address - Phone:919-845-7445
Practice Address - Fax:919-845-7443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHSP-P #2253103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0288MOtherBLUE CROSS/BLUE SHIELD