Provider Demographics
NPI:1457647521
Name:PSYCHOTHERAPEUTIC COMMUNITY SERVICES ASSOC
Entity Type:Organization
Organization Name:PSYCHOTHERAPEUTIC COMMUNITY SERVICES ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CLENDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-810-2465
Mailing Address - Street 1:400 W MAIN ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701
Mailing Address - Country:US
Mailing Address - Phone:410-778-9114
Mailing Address - Fax:410-778-7988
Practice Address - Street 1:400 W MAIN ST
Practice Address - Street 2:SUITE 501
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701
Practice Address - Country:US
Practice Address - Phone:336-269-1774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty