Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | ||
N | 102L00000X | Psychologist | 1746 | NC |
N | 103T00000X | Psychologist | 1746 | NC |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 1746 | NC |
N | 103G00000X | Clinical Psychologist | 1746 | NC |
N | 103TC0700X | Clinical Psychologist | 1746 | NC |
N | 103TC1900X | Counseling Psychologist | 1746 | NC |
NPI | 1366426819 |
---|---|
Provider Name | Dr. Marvin Burt Poston JR. |
First Address | Charlotte, NC 28209-0221 |
Second Address | Charlotte, NC 28209-3236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0362H | BCBS (01) | NC |
6000549 | (05) | NC |
VARIOUS COMPANIES | PROVIDER NUMBERS? (01) |