| Tidal Neuropsychology Pllc | |
|
19 S Hampstead Village Dr Hampstead NC 28443-3934 | |
| (910) 803-1434 | |
| (855) 672-7002 |
| Full Name | Tidal Neuropsychology Pllc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 19 S Hampstead Village Dr, Hampstead, North Carolina |
| Authorized Official Name and Position | Griffin Pollock Sutton (OWNER, MEMBER) |
| Authorized Official Contact | 9108031434 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tidal Neuropsychology Pllc Po Box 970 Hampstead NC 28443-0970 Ph: (910) 803-1434 | Tidal Neuropsychology Pllc 19 S Hampstead Village Dr Hampstead NC 28443-3934 Ph: (910) 803-1434 |
| NPI Number | 1871999565 |
|---|---|
| Provider Enumeration Date | 11/07/2014 |
| Last Update Date | 11/07/2014 |
| Medicare PECOS PAC ID | 6709109614 |
|---|---|
| Medicare Enrollment ID | O20141230000994 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871999565 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 4633 (North Carolina) | Primary |
| 103TC0700X | Psychologist - Clinical | 4633 (North Carolina) | Secondary |
| Provider Name | Griffin Pollock Sutton |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1992100465 PECOS PAC ID: 7517280423 Enrollment ID: I20141230001037 |
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