NPIMap

Organization Active NPI

Woodlake Psychological and Psychiatric Associates, PLLC

  • Clinical Social Worker
  • Jamestown, NC
National Provider Identifier
1154375236
Registry record updated Dec 1, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
COOO666 Issued in NC
Legal business name
WOODLAKE PSYCHOLOGICAL AND PSYCHIATRIC ASSOCIATES, PLLC
Practice address
725 W Main St
Jamestown, NC 27282-7506
Phone
(336) 889-6800
Fax
(336) 889-6800
NPI assigned
May 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Sheila Stone Polinsky, LCSW
Title
Office Manager
Phone
(336) 889-6800

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 1242 NC
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X COOO666 NC Primary

Addresses

Primary practice location

725 W Main St
Jamestown, NC 27282-7506

Mailing address

PO Box 772
Jamestown, NC 27282-0772
Phone (336) 889-6800

National Provider Directory

National Provider Directory

Locations

1836 Eastchester Dr
Ste 100
High Point, NC 27265
Phone (336) 659-9817

725 W Main St
Jamestown, NC 27282
Phone (336) 889-6800

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259625600000",
    "number": "1154375236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 772",
            "city": "JAMESTOWN",
            "state": "NC",
            "postal_code": "272820772",
            "telephone_number": "336-889-6800",
            "fax_number": "336-889-6800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 W MAIN ST",
            "city": "JAMESTOWN",
            "state": "NC",
            "postal_code": "272827506",
            "telephone_number": "336-889-6800",
            "fax_number": "336-889-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODLAKE PSYCHOLOGICAL AND PSYCHIATRIC ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-21",
        "last_updated": "2009-12-01",
        "status": "A",
        "authorized_official_last_name": "POLINSKY",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_middle_name": "STONE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "336-889-6800",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "1242",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "COOO666",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamestown, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 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.

Verify at the official NPI Registry.