Provider Demographics
NPI:1336336023
Name:PARKTOWNE PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:PARKTOWNE PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:BURT
Authorized Official - Last Name:POSTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:PSYD
Authorized Official - Phone:704-522-8490
Mailing Address - Street 1:1515 MOCKINGBIRD LN
Mailing Address - Street 2:SUITE 212
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3236
Mailing Address - Country:US
Mailing Address - Phone:704-522-8490
Mailing Address - Fax:
Practice Address - Street 1:1515 MOCKINGBIRD LN
Practice Address - Street 2:SUITE 212
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3236
Practice Address - Country:US
Practice Address - Phone:704-522-8490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1746103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2345099OtherMEDICARE GROUP NUMBER