Provider Demographics
NPI:1639536139
Name:PSYCHOTHERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:PSYCHOTHERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCAWS
Authorized Official - Phone:336-538-6990
Mailing Address - Street 1:400 W MAIN ST STE 501
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-3295
Mailing Address - Country:US
Mailing Address - Phone:919-530-8888
Mailing Address - Fax:
Practice Address - Street 1:400 W MAIN ST STE 501
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3295
Practice Address - Country:US
Practice Address - Phone:919-530-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PSYCHOTHERAPEUTIC SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management