Organization
THE GATHERING SPACE, LLC
Active
Organization
THE GATHERING SPACE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY LYNNAE JOHNSON (CEO)
(919) 695-3478
Entity
Organization
Contact information
Practice address
2216 S MIAMI BLVD STE 103, DURHAM, NC 27703-6284
(919) 695-3478
Mailing address
112 ELMSFORD ST, DURHAM, NC 27703-7874
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
3936
NC
Other
Enumeration date
12/11/2015
Last updated
12/11/2015
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