Healthcare Provider Details

I. General information

NPI: 1376160218
Provider Name (Legal Business Name): COMPASS FAMILY THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3326 GUESS RD STE 207
DURHAM NC
27705-2160
US

IV. Provider business mailing address

3326 GUESS RD STE 207
DURHAM NC
27705-2160
US

V. Phone/Fax

Practice location:
  • Phone: 973-868-3805
  • Fax:
Mailing address:
  • Phone: 973-868-3805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: RICK ROTHMAN
Title or Position: CO-OWNER
Credential: MSW, LCSW
Phone: 973-868-3805