Provider Demographics
NPI:1033358312
Name:PSYCHOTHERAPEUTIC SERVICES, INC.
Entity Type:Organization
Organization Name:PSYCHOTHERAPEUTIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:L
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:410-778-9114
Mailing Address - Street 1:870 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-3914
Mailing Address - Country:US
Mailing Address - Phone:410-778-9114
Mailing Address - Fax:410-778-7988
Practice Address - Street 1:3 CENTERVIEW DR
Practice Address - Street 2:THE HICKORY BUILDING, SUITE 150
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3725
Practice Address - Country:US
Practice Address - Phone:336-834-9664
Practice Address - Fax:336-834-9698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty