Provider Demographics
NPI:1598334948
Name:HEARST PSYCHOTHERAPY
Entity Type:Organization
Organization Name:HEARST PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEARST
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:704-951-4859
Mailing Address - Street 1:3020I PROSPERITY CHURCH RD # 964
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-8112
Mailing Address - Country:US
Mailing Address - Phone:704-951-4859
Mailing Address - Fax:
Practice Address - Street 1:3420 ARKLOW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0778
Practice Address - Country:US
Practice Address - Phone:704-951-4859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)