Provider Demographics
NPI:1750044426
Name:EAST COAST TELEPSYCHIATRY
Entity Type:Organization
Organization Name:EAST COAST TELEPSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, NP
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:PHARR
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:843-299-2033
Mailing Address - Street 1:861 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LOTTSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22511-2667
Mailing Address - Country:US
Mailing Address - Phone:804-246-4942
Mailing Address - Fax:843-299-2474
Practice Address - Street 1:268 NORTHUMBERLAND HWY
Practice Address - Street 2:
Practice Address - City:CALLAO
Practice Address - State:VA
Practice Address - Zip Code:22435-2222
Practice Address - Country:US
Practice Address - Phone:804-246-4942
Practice Address - Fax:843-299-2474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-19
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty