Provider Demographics
NPI:1699549931
Name:OMNI PSYCHOLOGICAL CENTER FOR TESTING & COUNSELING PLLC
Entity type:Organization
Organization Name:OMNI PSYCHOLOGICAL CENTER FOR TESTING & COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGICAL ASSOCIATE
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPA
Authorized Official - Phone:743-223-4687
Mailing Address - Street 1:7 CORPORATE CENTER CT STE B
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-3839
Mailing Address - Country:US
Mailing Address - Phone:743-223-4687
Mailing Address - Fax:743-229-3229
Practice Address - Street 1:7 CORPORATE CENTER CT STE B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-3839
Practice Address - Country:US
Practice Address - Phone:743-223-4687
Practice Address - Fax:743-229-3229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty