Provider Demographics
NPI:1003069188
Name:ACCESS THERAPY SERVICES
Entity Type:Organization
Organization Name:ACCESS THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FONGHEISER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MS, MAC, LCAS
Authorized Official - Phone:704-813-4555
Mailing Address - Street 1:3140 HWY 16 N.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28036-7314
Mailing Address - Country:US
Mailing Address - Phone:704-813-4555
Mailing Address - Fax:704-296-5500
Practice Address - Street 1:409 ARROWOOD AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-1503
Practice Address - Country:US
Practice Address - Phone:704-813-4555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC945101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6112011Medicaid