Provider Demographics
NPI:1417370818
Name:ASCEND PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:ASCEND PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOWERSOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-202-2056
Mailing Address - Street 1:PO BOX 271
Mailing Address - Street 2:
Mailing Address - City:ROCKWELL
Mailing Address - State:NC
Mailing Address - Zip Code:28138-0271
Mailing Address - Country:US
Mailing Address - Phone:704-202-2056
Mailing Address - Fax:704-279-0344
Practice Address - Street 1:110A EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:ROCKWELL
Practice Address - State:NC
Practice Address - Zip Code:28138
Practice Address - Country:US
Practice Address - Phone:704-279-0626
Practice Address - Fax:704-279-0344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101Y00000X
101YM0800X, 101YP2500X, 103T00000X
NC4413103T00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1447536792OtherNPI TYPE 1