Provider Demographics
NPI:1407696768
Name:PSYCHOLOGICAL ASSESSMENT CENTER OF CHARLOTTE, PLLC
Entity type:Organization
Organization Name:PSYCHOLOGICAL ASSESSMENT CENTER OF CHARLOTTE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:704-604-2371
Mailing Address - Street 1:8510 PROSSER WAY UNIT 304
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-1023
Mailing Address - Country:US
Mailing Address - Phone:704-604-2371
Mailing Address - Fax:
Practice Address - Street 1:9929 ALBEMARLE RD STE 4C
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-3371
Practice Address - Country:US
Practice Address - Phone:704-604-2371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical