Provider Demographics
NPI:1518100254
Name:MY THERAPIST, INC
Entity Type:Organization
Organization Name:MY THERAPIST, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:CULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:919-795-0101
Mailing Address - Street 1:9228 LINSLADE WAY
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-5023
Mailing Address - Country:US
Mailing Address - Phone:919-795-0101
Mailing Address - Fax:
Practice Address - Street 1:9228 LINSLADE WAY
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-5023
Practice Address - Country:US
Practice Address - Phone:919-795-0101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1106106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty