Provider Demographics
NPI:1699812651
Name:PSYCH SUPPORT INC.
Entity type:Organization
Organization Name:PSYCH SUPPORT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-850-3480
Mailing Address - Street 1:211 E SIX FORKS RD
Mailing Address - Street 2:BLDG. C SUITE 108
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7745
Mailing Address - Country:US
Mailing Address - Phone:919-850-3480
Mailing Address - Fax:919-899-6330
Practice Address - Street 1:211 E SIX FORKS RD
Practice Address - Street 2:BLDG. C SUITE 108
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7745
Practice Address - Country:US
Practice Address - Phone:919-850-3480
Practice Address - Fax:919-899-6330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89016N3Medicaid
NC8301505Medicaid
NC8301505GMedicaid
NC6005068Medicaid
NC89016N3Medicaid
NC6005068Medicaid