Provider Demographics
NPI:1497100689
Name:UPTOWN PSYCHOTHERAPY, PLLC
Entity Type:Organization
Organization Name:UPTOWN PSYCHOTHERAPY, PLLC
Other - Org Name:UPTOWN PSYCHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:704-333-8861
Mailing Address - Street 1:1818 LOMBARDY CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6056
Mailing Address - Country:US
Mailing Address - Phone:704-412-4046
Mailing Address - Fax:800-682-8178
Practice Address - Street 1:1818 LOMBARDY CIR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-6056
Practice Address - Country:US
Practice Address - Phone:704-412-4046
Practice Address - Fax:800-682-8178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4838101YP2500X
NCA10859101YP2500X
NCC0030401041C0700X
NCC0049811041C0700X
NCC0046731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty