Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 541 | NC |
Y | 103T00000X | Psychologist | 541 | NC |
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
N | 103TC1900X | Counseling Psychologist | ||
N | 103TM1800X | Intellectual & Developmental Disabilities | 541 | NC |
NPI | 1063586253 |
---|---|
Provider Name | Mr. William Wade Brown |
First Address | Morganton, NC 28655-9671 |
Second Address | Morganton, NC 28655-9671 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 15/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6107070 | (05) | NC |