Southeastern Psychological Services

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

SOUTHEASTERN PSYCHOLOGICAL SERVICES

Practice address

302 N Main St
Fairmont, NC 28340-1730

Phone

(910) 628-6718

Fax

(910) 628-6719

NPI assigned

Jul 29, 2005

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Linda Oliver-Link

Title

Administrative Director

Phone

(910) 682-6718

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1122595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1952301079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 N MAIN ST",
            "address_2": "PO BOX 369",
            "city": "FAIRMONT",
            "state": "NC",
            "postal_code": "283401730",
            "telephone_number": "910-628-6718",
            "fax_number": "910-628-6719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 N MAIN ST",
            "city": "FAIRMONT",
            "state": "NC",
            "postal_code": "283401730",
            "telephone_number": "910-628-6718",
            "fax_number": "910-628-6719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN PSYCHOLOGICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-29",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "OLIVER-LINK",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "ADMINISTRATIVE DIRECTOR",
        "authorized_official_telephone_number": "910-682-6718",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0384M",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1318H",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005435",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Southeastern Regional Medical Center (Fairmont Medical Clinic)
• Southeastern Regional Physician Services (Fairmont Medical Clinic)
• Melissa Johanna Spencer, LPC
• Sprouting Therapy Services, PLLC
• Stephens Outreach Center, Inc

• Specialist in Fairmont, NC
• Providers in Fairmont, NC by specialty
• Specialist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.