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General NPI Number Information
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NPI Number | 1619161718
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Entity Type | Organization
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Legal Business Name | PSYCHOTHERAPEUTIC SERVICES
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Dates
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Enumeration Date | 08/31/2007
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 2260 S CHURCH ST SUITE 304
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City | BURLINGTON
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State | NC
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Zip | 21215
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Country | US
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Telephone | 336-513-4229
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Fax | 336-513-4228
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Provider Business Mailing Address
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Address Line | 104 SPRING AVE UNIT 299
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City | CHESTERTOWN
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State | MD
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Zip | 21620-8512
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Country | US
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Telephone | 410-778-9114
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Fax | 410-778-7988
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Authorized Official
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Title or Position | TREASURER & CONTROLLER
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Name | ERIN OLIVER
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Credential |
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Telephone | 410-778-1099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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