| Organization Name: | FAYETTEVILLE PSYCHIATRIC ASSOCIATES, PC |
| NPI Number: | 1538537519 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBERT K MATLACK (OWNER) |
| Mailing Address: | 600 Stellata Dr Fuquay Varina |
| State: | NC US |
| Postal Code: | 275261905 |
| Phone Number: | 9195670684 |
| Fax Number: | |
| NPI Enumeration Date: | 09/09/2015 |
| NPI Last Update Date: | 09/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | A9626 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |