Provider Demographics
NPI:1588099618
Name:PINEHURST NEUROPSYCHOLOGY, PLLC
Entity type:Organization
Organization Name:PINEHURST NEUROPSYCHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-619-1772
Mailing Address - Street 1:45 AVIEMORE DR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9797
Mailing Address - Country:US
Mailing Address - Phone:919-420-8041
Mailing Address - Fax:910-420-7081
Practice Address - Street 1:45 AVIEMORE DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9797
Practice Address - Country:US
Practice Address - Phone:919-420-8041
Practice Address - Fax:910-420-7081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty