Provider Demographics
NPI:1588957724
Name:ZARLE THERAPEUTIC SERVICES
Entity type:Organization
Organization Name:ZARLE THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATION OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:ALFRED
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CCSOTS, NCC
Authorized Official - Phone:910-650-2227
Mailing Address - Street 1:2444 COMMERCE ROAD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7560
Mailing Address - Country:US
Mailing Address - Phone:910-650-2227
Mailing Address - Fax:910-346-2393
Practice Address - Street 1:2440 COMMERCE ROAD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7560
Practice Address - Country:US
Practice Address - Phone:910-650-2227
Practice Address - Fax:901-401-1322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6981101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6008695Medicaid