Provider Demographics
NPI:1366724569
Name:ASA THERAPEUTIC SERVICES, PLLC
Entity type:Organization
Organization Name:ASA THERAPEUTIC SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-938-1300
Mailing Address - Street 1:200 VALENCIA DR STE 128
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6313
Mailing Address - Country:US
Mailing Address - Phone:910-938-1300
Mailing Address - Fax:910-938-2900
Practice Address - Street 1:200 VALENCIA DR STE 128
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6313
Practice Address - Country:US
Practice Address - Phone:910-938-1300
Practice Address - Fax:910-938-2900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty