Organization
PSYCHOTHERAPEUTIC SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL COOPER CPA (CFO)
(410) 778-9114
Entity
Organization
Contact information
Practice address
1990 ALLEN RD STE F, GREENVILLE, NC 27834-0058
(252) 756-1005
(252) 756-1085
Mailing address
PO BOX 690, CHESTERTOWN, MD 21620-0690
(410) 778-9114
(410) 778-7988
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8301181
—
NC
01
—
8301181B
COMMUNITY SUPPORT SERVICE
NC
Enumeration date
02/14/2007
Last updated
08/17/2007
Update your record
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