Provider Demographics
NPI:1841962602
Name:THERAPY GROUP OF CHARLOTTE LLC
Entity type:Organization
Organization Name:THERAPY GROUP OF CHARLOTTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:202-986-5941
Mailing Address - Street 1:125 REMOUNT RD STE C1
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6459
Mailing Address - Country:US
Mailing Address - Phone:980-580-3532
Mailing Address - Fax:
Practice Address - Street 1:125 REMOUNT RD STE C1
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-6459
Practice Address - Country:US
Practice Address - Phone:980-580-3532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty