Organization
DYNAMIC GROUP SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINA BAZEMORE MSW, PLCAS (EXECUTIVE DIRECTOR)
(919) 747-9172
Entity
Organization
Contact information
Practice address
6920 SPANGLERS SPRING WAY, RALEIGH, NC 27610-6180
(910) 263-6425
Mailing address
6920 SPANGLERS SPRING WAY, RALEIGH, NC 27610-6180
(910) 263-6425
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
Other
Enumeration date
12/05/2011
Last updated
12/05/2011
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