Doctor Name: | SATION KONCHELLAH |
NPI Number: | 1144613043 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 1068603 |
Business Practice Address: | 214 N Marshall St Graham, NC - 272533006 |
Business Phone Number: | 3362145188 |
Business Fax Number: | |
Mailing Address: | Po Box 122, SEDALIA |
State: | NC |
Postal Code: | 27342 |
Phone Number: | 3364945743 |
Fax Number: | |
NPI Enumeration Date: | 03/17/2015 |
NPI Last Update Date: | 10/16/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | 1068603 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |