Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 955 | NC |
N | 103TA0700X | Adult Development & Aging Psychologist | 955 | NC |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 955 | NC |
N | 103G00000X | Clinical Psychologist | 955 | NC |
N | 103TC0700X | Clinical Psychologist | 955 | NC |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 955 | NC |
N | 103TF0000X | Family Psychologist | 955 | NC |
N | 103TF0200X | Forensic Psychologist | 955 | NC |
N | 103TH0100X | Health Service | 955 | NC |
N | 103TM1800X | Intellectual & Developmental Disabilities | ||
N | 103TP2701X | Group Psychotherapist | 955 | NC |
NPI | 1578787982 |
---|---|
Provider Name | Dr. Carl Nicholas Cordoni |
First Address | Jacksonville, NC 28546-9769 |
Second Address | Jacksonville, NC 28546-5708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2818511 | (05) | NC |