| Psychological Mobile Services, Pa | |
|
2401 Wooten Blvd Sw Ste K Wilson NC 27893-4464 | |
| (919) 252-8896 | |
| Not Available |
| Full Name | Psychological Mobile Services, Pa |
|---|---|
| Speciality | Psychologist |
| Location | 2401 Wooten Blvd Sw Ste K, Wilson, North Carolina |
| Authorized Official Name and Position | Steven N Hannant (OWNDER) |
| Authorized Official Contact | 9192528896 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychological Mobile Services, Pa 779 True Vine Rd Ne Pikeville NC 27863-8800 Ph: (919) 252-8896 | Psychological Mobile Services, Pa 2401 Wooten Blvd Sw Ste K Wilson NC 27893-4464 Ph: (919) 252-8896 |
| NPI Number | 1104179340 |
|---|---|
| Provider Enumeration Date | 10/25/2012 |
| Last Update Date | 11/02/2012 |
| Medicare PECOS PAC ID | 9931349040 |
|---|---|
| Medicare Enrollment ID | O20130715000346 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104179340 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 3681 (North Carolina) | Primary |
| Provider Name | Dorcas J Miller |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1730167461 PECOS PAC ID: 2062441710 Enrollment ID: I20050811001135 |
| Provider Name | Regan L Hannant |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497780191 PECOS PAC ID: 1850319138 Enrollment ID: I20051104000407 |
| Provider Name | Manijeh Boustani |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1134215031 PECOS PAC ID: 3678676525 Enrollment ID: I20070313000570 |
| Provider Name | Jerry L Brittain |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1972516367 PECOS PAC ID: 0446439830 Enrollment ID: I20110201000778 |
| Provider Name | Steven N Hannant |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1811013790 PECOS PAC ID: 3274709175 Enrollment ID: I20120529000610 |
| Provider Name | Tommel D Hayes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467789776 PECOS PAC ID: 6002060670 Enrollment ID: I20130207000044 |
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