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General NPI Number Information
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NPI Number | 1649341488
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Entity Type | Organization
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Legal Business Name | PSYCHOTHERAPEUTIC SERVICES, INC
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2260 S. CHURCH ST SUITE 303
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City | BURLINGTON
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State | NC
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Zip | 27215
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Country | US
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Telephone | 336-538-6990
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Fax | 336-538-6991
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Provider Business Mailing Address
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Address Line | 2260 S CHURCH ST SUITE 303
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City | BURLINGTON
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State | NC
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Zip | 27215
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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 | BILLING MANAGER
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Name | MARCIA LYNN CLENDANIEL
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Credential |
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Telephone | 410-810-2465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number | 231369010
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License Number State | NC
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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 | NC
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