Provider Demographics
NPI:1023075207
Name:SANDRA M. STORY, PSY.D., P.C.
Entity type:Organization
Organization Name:SANDRA M. STORY, PSY.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:SANDRA
Authorized Official - Last Name:STORY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, PC
Authorized Official - Phone:919-844-8711
Mailing Address - Street 1:8512 SIX FORKS RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2962
Mailing Address - Country:US
Mailing Address - Phone:919-844-8711
Mailing Address - Fax:919-844-8706
Practice Address - Street 1:8512 SIX FORKS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2962
Practice Address - Country:US
Practice Address - Phone:919-844-8711
Practice Address - Fax:919-844-8706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-29
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2659103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000365Medicaid
NC045JAOtherBCBS PROVIDER NUMBER
NC045JAOtherBCBS PROVIDER NUMBER