Provider Demographics
NPI:1013784727
Name:POSITIVELY PSYCHED
Entity Type:Organization
Organization Name:POSITIVELY PSYCHED
Other - Org Name:POSITIVELY PSYCHED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND BUSINESS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:DOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-639-8990
Mailing Address - Street 1:2680 US HIGHWAY 70
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-9095
Mailing Address - Country:US
Mailing Address - Phone:336-639-8990
Mailing Address - Fax:336-639-7266
Practice Address - Street 1:2680 US HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-9095
Practice Address - Country:US
Practice Address - Phone:336-639-8990
Practice Address - Fax:336-639-7266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health