TIDAL NEUROPSYCHOLOGY PLLC (NPI# 1871999565) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871999565 |
| Entity Type | Organization |
| Organization Name | TIDAL NEUROPSYCHOLOGY PLLC |
| Practice Address |
19 S Hampstead Village Dr Hampstead NC 28443-3934 |
| Mailing Address |
Po Box 970 Hampstead NC 28443-0970 |
| Practice Telephone | 9108031434 |
| Practice Fax Number | 8556727002 |
| Mailing Telephone | 9108031434 |
| Mailing Fax Number | 8556727002 |
| Enumeration Date | 2014-11-07 |
| Last Update Date | 2014-11-07 |
| Authorized Official Name | DR. GRIFFIN POLLOCK SUTTON (OWNER, MEMBER) |
| Authorized Official Telephone | 9108031434 |
| Authorized Official Credential | PH.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TC0700X |
Psychologist Specialization: Clinical |
4633 | NC | Behavioral Health & Social Service Providers |
| Y | 103G00000X | Clinical Neuropsychologist | 4633 | NC | Behavioral Health & Social Service Providers |
| Street Address |
19 S HAMPSTEAD VILLAGE DR |
| City | HAMPSTEAD |
| State | NC |
| Zip Code | 28443-3934 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992100465 | Griffin Pollock Sutton | Clinical Neuropsychologist | 19 S Hampstead Village Dr, Hampstead, NC 28443-3934 | 2014-10-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780284745 | Jenean Lacorte | Specialist/Technologist, Other | 18676 Hwy 17 N., Suite 11, Hampstead, NC 28443 | 2020-10-29 |
| 1457966947 | Lauren Paige Nester | Registered Nurse | 113 Pagoda Ct., Hampstead, NC 28443 | 2020-09-10 |
| 1326503657 | Village Pharmacy of Hampstead Inc | Pharmacy | 14057 Hwy 17, Suite 100, Hampstead, NC 28443 | 2019-01-31 |
| 1154896280 | Arbor Landing At Hampstead LLC | Custodial Care Facility | 1397 Us Hwy 17 North, Hampstead, NC 28443 | 2018-10-04 |
| 1134580178 | William Boone | Specialist/Technologist | 106 Katydid Ct, Hampstead, NC 28443 | 2016-03-18 |
| 1679959837 | New River Wellness, Pa | Social Worker | 15444 Us Highway 17 North, Bldg 233, Hampstead, NC 28443 | 2015-08-10 |
| 1932509791 | Laura Behr Jarosz | Physician Assistant | 114 Osier Dr, Hampstead, NC 28443 | 2014-08-29 |
| 1053737064 | Katelyn Braswell | Student in an Organized Health Care Education/Training Program | 309 Knollwood Dr, Hampstead, NC 28443 | 2014-03-14 |
| 1598101826 | Johnson Drug Hampstead Inc. | Pharmacy | 17230 Us Hwy 17n, Suite 222, Hampstead, NC 28443 | 2013-05-14 |
| 1053658302 | James William Boyer | Specialist/Technologist, Other | 1768 Hwy 210, Hampstead, NC 28443 | 2013-01-07 |
| Find all providers in zip 28443 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992100465 | Griffin Pollock Sutton | Clinical Neuropsychologist | 19 S Hampstead Village Dr, Hampstead, NC 28443-3934 | 2014-10-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467051458 | The Family Advocates | Clinical Neuropsychologist | 1201 Jade Glen Dr, Charlotte, NC 28262-1621 | 2020-10-20 |
| 1780118687 | Thomas Farrer | Clinical Neuropsychologist | 153 Carden Pl Apt C, Mebane, NC 27302-6080 | 2017-04-18 |
| 1891248795 | Anna Elizabeth Craig | Clinical Neuropsychologist | 20 W Colony Pl Ste 230, Durham, NC 27705-5577 | 2016-07-27 |
| 1063890614 | Michelle Jones Cueva | Clinical Neuropsychologist | 2218 Nelson Hwy, Suite 2, Chapel Hill, NC 27517-8923 | 2015-05-15 |
| 1861818874 | Dr. Angela Houser-betti, Psyd, Pllc | Clinical Neuropsychologist | 4425 Randolph Rd Ste 208, Charlotte, NC 28211-2324 | 2014-03-14 |
| 1629499819 | Bay Area Psychology Associates | Clinical Neuropsychologist | 302 Woodberry Pl, Jacksonville, NC 28540-4264 | 2013-12-14 |
| 1790117679 | Kimberly Leon | Clinical Neuropsychologist | 1001 Blythe Blvd Ste 200d, Charlotte, NC 28203-6215 | 2013-08-02 |
| 1811260730 | Silber Psychological Services P.a. | Clinical Neuropsychologist | 1340 Se Maynard Rd, Suite 201, Cary, NC 27511-3632 | 2012-02-23 |
| 1881967222 | Taeh Allison Ward | Clinical Neuropsychologist | 45 Aviemore Dr, Pinehurst, NC 28374-9797 | 2012-02-15 |
| 1871887562 | Karen Dorothy Sullivan | Clinical Neuropsychologist | 101 Manning Dr Cb 7200, Chapel Hill, NC 27599-4817 | 2011-05-31 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.