Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 103409 | NC |
Y | 103T00000X | Psychologist | 103409 | NC |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 103409 | NC |
N | 103G00000X | Clinical Psychologist | 103409 | NC |
N | 103TC0700X | Clinical Psychologist | 103409 | NC |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 103409 | NC |
N | 103TF0000X | Family Psychologist | 103409 | NC |
N | 103TH0100X | Health Service | 103409 | NC |
N | 103TS0200X | School Psychologist | 103409 | NC |
NPI | 1205509841 |
---|---|
Provider Name | Dr. Carly Bobal |
First Address | Mooresville, NC 28117-5962 |
Second Address | Charlotte, NC 28210-3102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2021 |
Last Update Date | 29/07/2021 |