Provider Demographics
NPI:1154378313
Name:TEMPLE, ELEANOR PAIGE (PHD)
Entity type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:PAIGE
Last Name:TEMPLE
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:PO BOX 613
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-0613
Mailing Address - Country:US
Mailing Address - Phone:252-823-6187
Mailing Address - Fax:252-641-0715
Practice Address - Street 1:511 SAINT ANDREW ST
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-4434
Practice Address - Country:US
Practice Address - Phone:252-823-6187
Practice Address - Fax:252-824-1580
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2884103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13416OtherBCBS OF NC--PSYCHOLOGIST
NC6000462Medicaid