Provider Demographics
NPI:1629399894
Name:RTC PSYCHOLOGICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:RTC PSYCHOLOGICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGICAL ASSOCIATE
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:704-663-1330
Mailing Address - Street 1:398 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-2454
Mailing Address - Country:US
Mailing Address - Phone:704-663-1330
Mailing Address - Fax:888-607-8320
Practice Address - Street 1:398 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2454
Practice Address - Country:US
Practice Address - Phone:704-663-1330
Practice Address - Fax:888-607-8320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-22
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1000103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1245403526OtherNPI INDIVIDUAL PROVIDER NUMBER FOR REBECCA CHURCH