Provider Demographics
NPI:1447337290
Name:CHAPEL HILL PEDIATRIC PSYCHOLOGY, PA
Entity type:Organization
Organization Name:CHAPEL HILL PEDIATRIC PSYCHOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:RIDDLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-942-4166
Mailing Address - Street 1:205 SAGE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-6995
Mailing Address - Country:US
Mailing Address - Phone:919-942-4166
Mailing Address - Fax:919-942-8693
Practice Address - Street 1:205 SAGE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-6995
Practice Address - Country:US
Practice Address - Phone:919-942-4166
Practice Address - Fax:919-942-8693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0256EOtherBCBS OF NC