Provider Demographics
NPI:1871679464
Name:PRESBYTERIAN PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:PRESBYTERIAN PSYCHOLOGICAL SERVICES
Other - Org Name:PRESBYTERIAN SAMARITAN COUNSELING CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BILLING AND INS ACCT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:WEISSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-554-9900
Mailing Address - Street 1:5203 SHARON RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-4721
Mailing Address - Country:US
Mailing Address - Phone:704-554-9900
Mailing Address - Fax:704-554-9956
Practice Address - Street 1:5203 SHARON RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-4721
Practice Address - Country:US
Practice Address - Phone:704-554-9900
Practice Address - Fax:704-554-9956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty