Active NPI
William Richard Mathis, MA
- Psychologist
- Pembroke, NC
National Provider Identifier
1093049199
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 0537
- Practice address
- 171 Comtech Dr
Pembroke, NC 28372-7270 - Phone
- (910) 736-3351
- NPI assigned
- Sep 23, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 0537 | NC | |
| Behavior Analyst | 103K00000X | 0537 | NC | |
| Psychologist | 103T00000X | 0537 | NC | Primary |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 537 | NC | |
| Intellectual & Developmental Disabilities Psychologist | 103TM1800X | 0537 | NC |
Addresses
Primary practice location
171 Comtech Dr
Pembroke, NC 28372-7270
Mailing address
402 Pinelake Park Rd
Pembroke, NC 28372-9212
Phone (910) 258-7796
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0537 | NC | MD | Behavioral Analyst |
| 537 | NC | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1261008000000",
"number": "1093049199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "402 PINELAKE PARK RD",
"city": "PEMBROKE",
"state": "NC",
"postal_code": "283729212",
"telephone_number": "910-258-7796"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "171 COMTECH DR",
"city": "PEMBROKE",
"state": "NC",
"postal_code": "283727270",
"telephone_number": "910-736-3351"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHIS",
"first_name": "WILLIAM",
"middle_name": "RICHARD",
"credential": "MA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-09-23",
"last_updated": "2009-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "NC",
"license": "0537",
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "NC",
"license": "0537",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NC",
"license": "0537",
"primary": true
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "NC",
"license": "537",
"primary": false
},
{
"code": "103TM1800X",
"taxonomy_group": "",
"desc": "Psychologist, Intellectual & Developmental Disabilities",
"state": "NC",
"license": "0537",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pembroke, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.