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General NPI Number Information
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NPI Number | 1558827568
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Entity Type | Organization
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Legal Business Name | MY THERAPY PLACE, PLLC
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Dates
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Enumeration Date | 02/14/2019
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Last Update Date | 08/11/2023
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Provider Practice Location Address
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Address Line | 1400 BATTLEGROUND AVE STE 209E
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City | GREENSBORO
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State | NC
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Zip | 27408-8028
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Country | US
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Telephone | 919-833-0397
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 BATTLEGROUND AVE SUITE 209-E
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City | GREENSBORO
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State | NC
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Zip | 27408-8028
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Country | US
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Telephone | 919-833-0397
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Fax |
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Authorized Official
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Title or Position | OUTPATIENT THERAPIST
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Name | MRS. CHRISTIE M MARTIN
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Credential | MSW, LCSW
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Telephone | 919-833-0397
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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