Provider Demographics
NPI:1548409261
Name:WAYNESBOROUGH PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:WAYNESBOROUGH PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-736-7900
Mailing Address - Street 1:2400 WAYNE MEMORIAL DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-1789
Mailing Address - Country:US
Mailing Address - Phone:919-736-7900
Mailing Address - Fax:919-736-2424
Practice Address - Street 1:2400 WAYNE MEMORIAL DR
Practice Address - Street 2:SUITE E
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-1789
Practice Address - Country:US
Practice Address - Phone:919-736-7900
Practice Address - Fax:919-736-2424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty