Organization
PSYCHOTHERAPEUTIC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARCIA LYNN CLENDANIEL (BILLING MANAGER)
(410) 810-2465
Entity
Organization
Contact information
Practice address
2260 S. CHURCH ST, SUITE 303, BURLINGTON, NC 27215
(336) 538-6990
(336) 538-6991
Mailing address
2260 S CHURCH ST, SUITE 303, BURLINGTON, NC 27215
(410) 778-9114
(410) 778-7988
Taxonomy
Speciality
Code
Description
License number
State
103TP2701X
Group Psychotherapy Psychologist
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8300588
—
NC
01
—
8300588S
PSYCHOSOCIAL REHAB
NC
Enumeration date
02/07/2007
Last updated
12/01/2016
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