Provider Demographics
NPI:1871851113
Name:P&G CLINICAL SERVICES PLLC
Entity Type:Organization
Organization Name:P&G CLINICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/LPC
Authorized Official - Prefix:
Authorized Official - First Name:LOREDANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAMPINELLA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD(C), LPC, LCAS-A
Authorized Official - Phone:704-408-8489
Mailing Address - Street 1:8201 ARROWRIDGE BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-5874
Mailing Address - Country:US
Mailing Address - Phone:704-408-8489
Mailing Address - Fax:855-532-2779
Practice Address - Street 1:8201 ARROWRIDGE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-5874
Practice Address - Country:US
Practice Address - Phone:704-408-8489
Practice Address - Fax:855-532-2779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00536787Medicaid