Provider Demographics
NPI:1558827568
Name:MY THERAPY PLACE, PLLC
Entity Type:Organization
Organization Name:MY THERAPY PLACE, PLLC
Other - Org Name:MY THERAPY PLACE, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OUTPATIENT THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:919-833-0397
Mailing Address - Street 1:1400 BATTLEGROUND AVE
Mailing Address - Street 2:SUITE 209-E
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-8028
Mailing Address - Country:US
Mailing Address - Phone:919-833-0397
Mailing Address - Fax:
Practice Address - Street 1:1400 BATTLEGROUND AVE STE 209E
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-8028
Practice Address - Country:US
Practice Address - Phone:919-833-0397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty