Provider Demographics
NPI:1306057112
Name:OVERSEER, LLC
Entity type:Organization
Organization Name:OVERSEER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ABA
Authorized Official - Middle Name:LOGAN
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:704-490-1342
Mailing Address - Street 1:1801 N TRYON ST
Mailing Address - Street 2:SUITE 105-B
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-2704
Mailing Address - Country:US
Mailing Address - Phone:704-940-1288
Mailing Address - Fax:704-940-1287
Practice Address - Street 1:1801 N TRYON ST
Practice Address - Street 2:SUITE 105-B
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-2704
Practice Address - Country:US
Practice Address - Phone:704-940-1288
Practice Address - Fax:704-940-1287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health