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General NPI Number Information
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NPI Number | 1336927425
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Entity Type | Organization
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Legal Business Name | MY THERAPY NC, PLLC
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Dates
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Enumeration Date | 09/19/2023
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | 2579 HARRIS HENRIETTA RD.
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City | MOORESBORO
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State | NC
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Zip | 28114
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Country | US
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Telephone | 704-300-6922
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 425
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City | HENRIETTA
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State | NC
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Zip | 28076-0425
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Country | US
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Telephone | 704-300-6922
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JERRY ASHLEY WEASE
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Credential | LCMHCS, LCAS, CCS
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Telephone | 704-300-6922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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