Organization
PSYCHOTHERPEUTIC 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
405 RUDD ST, BURLINGTON, NC 27217-2957
(336) 513-4229
(336) 513-4228
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
—
8300589
—
NC
01
—
8300589B
COMMUNITY SUPPORT SERVICE
NC
Enumeration date
02/14/2007
Last updated
08/22/2020
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