Healthcare Provider Details

I. General information

NPI: 1609317569
Provider Name (Legal Business Name): CERTUS PSYCHIATRY AND INTEGRATED CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2017
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 CREEKSHIRE WAY SUITE 270
WINSTON SALEM NC
27103-3059
US

IV. Provider business mailing address

1255 CREEKSHIRE WAY SUITE 270
WINSTON SALEM NC
27103-3059
US

V. Phone/Fax

Practice location:
  • Phone: 954-658-9768
  • Fax:
Mailing address:
  • Phone: 336-701-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number200900831
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: GISELA KOHL
Title or Position: PRESIDENT
Credential: MD
Phone: 954-658-9768