Individual provider Active NPI

Allison Agro, PSY.D.

  • Psychologist
  • Swansboro, NC
National Provider Identifier
1578870283
Registry record updated Oct 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
3982 Issued in NC
Practice address
638 W Corbett Ave Ste B
Swansboro, NC 28584-8450
Phone
(919) 345-1588
NPI assigned
Sep 2, 2010
Last updated
Oct 7, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 7, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 3982 NC Primary
Clinical Psychologist 103TC0700X 3982 NC

Addresses

Primary practice location

638 W Corbett Ave Ste B
Swansboro, NC 28584-8450

Mailing address

638 W Corbett Ave Ste B
Swansboro, NC 28584-8450
Phone (919) 345-1588

Other practice location 1

3205 Randall Pkwy Ste 105
Wilmington, NC 28403-2565
Phone (910) 742-9243

Other identifiers 1

IdentifierTypeStateIssuer
6001252MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101130000696 NC Practitioner - Clinical Psychologist 7315133576

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
3982NCMDPublic Health Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Lifesource of North Carolina Psychologist CurrentSince Oct 1, 2025 Accepting new patients
Lifesource of North Carolina Clinical CurrentSince Oct 1, 2025 Accepting new patients

Locations

3205 Randall Pkwy
Ste 105
Wilmington, NC 28403
Phone (910) 338-2880

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1283385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759795200000",
    "number": "1578870283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "638 W CORBETT AVE STE B",
            "city": "SWANSBORO",
            "state": "NC",
            "postal_code": "285848450",
            "telephone_number": "919-345-1588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "638 W CORBETT AVE STE B",
            "city": "SWANSBORO",
            "state": "NC",
            "postal_code": "285848450",
            "telephone_number": "919-345-1588"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3205 Randall Pkwy Ste 105",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284032565",
            "country_code": "US",
            "telephone_number": "910-742-9243",
            "fax_number": "888-746-1787",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AGRO",
        "first_name": "ALLISON",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-09-02",
        "last_updated": "2025-10-07",
        "certification_date": "2025-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "3982",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "3982",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6001252",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Swansboro, NC

Sources for this page

Verify at the official NPI Registry.