Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3577 | NC |
Y | 103T00000X | Psychologist | 3577 | NC |
N | 103TS0200X | School Psychologist | 026 | NC |
NPI | 1104060771 |
---|---|
Provider Name | Ms. Anita Cannon Mcgaha |
First Address | Fayetteville, NC 28304-1920 |
Second Address | Fayetteville, NC 28305-5189 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2009 |
Last Update Date | 23/11/2021 |