Tidal Neuropsychology PLLC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

4633 Issued in NC

Legal business name

TIDAL NEUROPSYCHOLOGY PLLC

Practice address

19 S Hampstead Village Dr
Hampstead, NC 28443-3934

Phone

(910) 803-1434

Fax

(855) 672-7002

NPI assigned

Nov 7, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Griffin Pollock Sutton, PH.D.

Title

Owner, Member

Phone

(910) 803-1434

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1415318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415318400000",
    "number": "1871999565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 970",
            "city": "HAMPSTEAD",
            "state": "NC",
            "postal_code": "284430970",
            "telephone_number": "910-803-1434",
            "fax_number": "855-672-7002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 S HAMPSTEAD VILLAGE DR",
            "city": "HAMPSTEAD",
            "state": "NC",
            "postal_code": "284433934",
            "telephone_number": "910-803-1434",
            "fax_number": "855-672-7002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDAL NEUROPSYCHOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-07",
        "last_updated": "2014-11-07",
        "status": "A",
        "authorized_official_last_name": "SUTTON",
        "authorized_official_first_name": "GRIFFIN",
        "authorized_official_middle_name": "POLLOCK",
        "authorized_official_title_or_position": "OWNER, MEMBER",
        "authorized_official_telephone_number": "910-803-1434",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "NC",
            "license": "4633",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "4633",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Hampstead, NC by specialty
• Clinical Neuropsychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2014; 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.