Provider Demographics
NPI:1194062786
Name:ASHEBORO BEHAVIORAL MEDICINE, PLLC
Entity type:Organization
Organization Name:ASHEBORO BEHAVIORAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GIARMO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:336-625-2073
Mailing Address - Street 1:727 S FAYETTEVILLE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-6497
Mailing Address - Country:US
Mailing Address - Phone:336-625-2073
Mailing Address - Fax:336-625-2727
Practice Address - Street 1:727 S FAYETTEVILLE ST
Practice Address - Street 2:SUITE C
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-6497
Practice Address - Country:US
Practice Address - Phone:336-625-2073
Practice Address - Fax:336-625-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8874101YP2500X
NC3067103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000864Medicaid
NC2822792CMedicare PIN