Provider Demographics
NPI:1487841458
Name:PSYCHLL INCORPORATED
Entity Type:Organization
Organization Name:PSYCHLL INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPSITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:919-942-9574
Mailing Address - Street 1:111 CLOISTER CT STE 100
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2295
Mailing Address - Country:US
Mailing Address - Phone:919-942-9574
Mailing Address - Fax:919-403-5511
Practice Address - Street 1:111 CLOISTER CT STE 100
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2295
Practice Address - Country:US
Practice Address - Phone:919-942-9574
Practice Address - Fax:919-403-5511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC-C0020671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty