Healthcare Provider Details

I. General information

NPI: 1720381395
Provider Name (Legal Business Name): THERAPEUTIC SPECIALTIES OF NORTH CAROLINA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2010
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 MARKET ST
HENDERSON NC
27537-3751
US

IV. Provider business mailing address

104 MARKET STREET
HENDERSON NC
27537
US

V. Phone/Fax

Practice location:
  • Phone: 252-431-4418
  • Fax: 252-572-2418
Mailing address:
  • Phone: 252-431-4418
  • Fax: 252-572-2418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
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 Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2332
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2348
License Number StateNC

VIII. Authorized Official

Name: MRS. TAMMY S JUNTUNEN
Title or Position: CO-OWNER
Credential: MA, LPA
Phone: 252-431-4418