=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891572467
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEVEN HILLS PSYCHIATRY AND BEHAVIORAL HEALTH SERVICES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2023
-----------------------------------------------------
Last Update Date | 09/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 COPPERFIELD BLVD NE
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28025-2453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-760-1026
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 COPPERFIELD BLVD NE
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28025-2453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-760-1026
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PMHNP-BC
-----------------------------------------------------
Name | LAKSHMI GANUGAPENTA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 989-760-1026
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------