Provider Demographics
NPI:1316125545
Name:PERSONALIZED THERAPY, INC.
Entity type:Organization
Organization Name:PERSONALIZED THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QA/QI DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:SAYERS
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-353-4968
Mailing Address - Street 1:925 CONFERENCE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5971
Mailing Address - Country:US
Mailing Address - Phone:252-353-4968
Mailing Address - Fax:252-353-4967
Practice Address - Street 1:1226 MANN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5532
Practice Address - Country:US
Practice Address - Phone:704-846-1625
Practice Address - Fax:704-846-1635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301790BMedicaid
NC8301790Medicaid
NC8301790GMedicaid