Basic Information
| Provider Information | |||||||||
| NPI: | 1750641213 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PERKINS COUNSELING AND PSYCHOLOGICAL SERVICES, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10580 LIGON MILL ROAD | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | WAKE FOREST | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192639592 | ||||||||
| FaxNumber: | 9192639670 | ||||||||
| Practice Location | |||||||||
| Address1: | 10580 LIGON MILL ROAD | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | WAKE FOREST | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192639592 | ||||||||
| FaxNumber: | 9192639670 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2012 | ||||||||
| LastUpdateDate: | 02/13/2018 | ||||||||
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| AuthorizedOfficialLastName: | MCCLAM | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9192639592 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 4257 | NC | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.