Provider Demographics
NPI:1619200417
Name:PIEDMONT PERFORMANCE EVALUATIONS, PLLC
Entity Type:Organization
Organization Name:PIEDMONT PERFORMANCE EVALUATIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSLYN
Authorized Official - Middle Name:MILLER
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPA
Authorized Official - Phone:704-763-7386
Mailing Address - Street 1:1945 JN PEASE PL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4511
Mailing Address - Country:US
Mailing Address - Phone:704-763-7386
Mailing Address - Fax:704-717-2440
Practice Address - Street 1:1945 JN PEASE PL
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4511
Practice Address - Country:US
Practice Address - Phone:704-763-7386
Practice Address - Fax:704-717-2440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1526101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006048Medicaid
NC144PEOtherBLUE CROSS BLUE SHIED