Organization Name: | SCHOOL SPECIFIED |
NPI Number: | 1245699016 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CASEY COOPER (CEO) |
Mailing Address: | 375 Sequoyah Trl Cherokee |
State: | NC US |
Postal Code: | 28719 |
Phone Number: | 8284979163 |
Fax Number: | 8284976977 |
NPI Enumeration Date: | 02/22/2016 |
NPI Last Update Date: | 02/22/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC2200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical Child & Adolescent |
Taxonomy Definition: |