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General NPI Number Information
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NPI Number | 1780276402
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Entity Type | Organization
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Legal Business Name | BUSY MIND PSYCHOLOGIST INC
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Dates
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Enumeration Date | 02/04/2021
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Last Update Date | 05/01/2023
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Provider Practice Location Address
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Address Line | 1026 JAY ST # B181
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City | CHARLOTTE
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State | NC
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Zip | 28208-4431
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Country | US
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Telephone | 754-900-5282
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Fax |
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Provider Business Mailing Address
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Address Line | 1026 JAY ST # B181
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City | CHARLOTTE
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State | NC
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Zip | 28208-4431
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Country | US
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Telephone | 754-900-5282
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DR. JESSICA BORUSHOK
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Credential | PHD
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Telephone | 754-900-5282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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