Provider Demographics
NPI:1720381395
Name:THERAPEUTIC SPECIALTIES OF NORTH CAROLINA, PLLC
Entity Type:Organization
Organization Name:THERAPEUTIC SPECIALTIES OF NORTH CAROLINA, PLLC
Other - Org Name:HENDERSON PSYCHOLOGICAL SERVICES, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:S
Authorized Official - Last Name:JUNTUNEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPA
Authorized Official - Phone:252-431-4418
Mailing Address - Street 1:104 MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27537
Mailing Address - Country:US
Mailing Address - Phone:252-431-4418
Mailing Address - Fax:252-572-2418
Practice Address - Street 1:104 MARKET ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27537-3751
Practice Address - Country:US
Practice Address - Phone:252-431-4418
Practice Address - Fax:252-572-2418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YP2500X, 103T00000X, 235Z00000X
NC2332251S00000X
NC2348251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107348Medicaid
NC6107074Medicaid