Provider Demographics
NPI:1306085683
Name:PSYCHOTHERAPEUTIC SERVICES
Entity type:Organization
Organization Name:PSYCHOTHERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CLENDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-810-2465
Mailing Address - Street 1:2260 S CHURCH ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215
Mailing Address - Country:US
Mailing Address - Phone:410-778-9114
Mailing Address - Fax:410-778-7988
Practice Address - Street 1:2260 S CHURCH ST
Practice Address - Street 2:SUITE 303
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215
Practice Address - Country:US
Practice Address - Phone:410-778-9114
Practice Address - Fax:410-778-7988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty