Healthcare Provider Details

I. General information

NPI: 1053801795
Provider Name (Legal Business Name): ON THE SPOT THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 05/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6176 US HIGHWAY 301 S
HOPE MILLS NC
28348-8573
US

IV. Provider business mailing address

PO BOX 910
HOPE MILLS NC
28348-0910
US

V. Phone/Fax

Practice location:
  • Phone: 910-302-6516
  • Fax:
Mailing address:
  • Phone: 910-302-6516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC010628
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: ANGEL MORGAN
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 910-302-6516