Healthcare Provider Details

I. General information

NPI: 1356809990
Provider Name (Legal Business Name): ATLANTIC CONSULTING AND THERAPY SPECIALISTS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2019
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3493-E EVANS STREET
GREENVILLE NC
27834-4535
US

IV. Provider business mailing address

3493 EVANS ST STE E
GREENVILLE NC
27834-4535
US

V. Phone/Fax

Practice location:
  • Phone: 252-565-8836
  • Fax: 252-565-8837
Mailing address:
  • Phone: 252-565-8836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL J CASCIO
Title or Position: OWNER
Credential: MSW, LCSW
Phone: 252-565-8836