Chrysalis Center for Counseling and Eating Disorder Treatment PLLC
NPI 1891865218ActiveOrganization· Psychologist· Wilmington, NC
Psychologist in Wilmington, North Carolina, registered in NPPES in November 2006. The authorized official on file is Macon Funderburk, Office Manager. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1891865218 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Nov 9, 2006 |
| Last updated in NPPES | Aug 21, 2024 |
| Certified by provider | Aug 21, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Psychologist Primary | 103T00000X | 2805 | NC |
| Psychologist, Counseling | 103TC1900X | LPC6828 | NC |
| Social Worker, Clinical | 1041C0700X | C006434 | NC |
| Dietitian, Registered | 133V00000X | L003399 | NC |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (NC) |
|---|
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