| Psychological Solutions Of Lake Norman, Pllc | |
|
344 Rolling Hill Rd Ste 105 Mooresville NC 28117 | |
| (704) 662-5459 | |
| Not Available |
| Full Name | Psychological Solutions Of Lake Norman, Pllc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 344 Rolling Hill Rd Ste 105, Mooresville, North Carolina |
| Authorized Official Name and Position | Phil F Icard (PSYCHOLOGIST) |
| Authorized Official Contact | 7046625459 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychological Solutions Of Lake Norman, Pllc 344 Rolling Hill Rd Ste 105 Mooresville NC 28117-6865 Ph: (704) 662-5459 | Psychological Solutions Of Lake Norman, Pllc 344 Rolling Hill Rd Ste 105 Mooresville NC 28117 Ph: (704) 662-5459 |
| NPI Number | 1285982413 |
|---|---|
| Provider Enumeration Date | 08/20/2012 |
| Last Update Date | 05/11/2022 |
| Certification Date | 05/11/2022 |
| Medicare PECOS PAC ID | 2365869997 |
|---|---|
| Medicare Enrollment ID | O20200827003334 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285982413 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 3846 (North Carolina) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Taeh A Ward |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1881967222 PECOS PAC ID: 5890017206 Enrollment ID: I20151105001030 |
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