Provider Demographics
NPI:1205630662
Name:BROADVIEW PSYCHOLOGICAL SERVICES PLLC
Entity type:Organization
Organization Name:BROADVIEW PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOTTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS ED, LPA
Authorized Official - Phone:919-646-2627
Mailing Address - Street 1:121 OCCIDENTAL DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-7070
Mailing Address - Country:US
Mailing Address - Phone:917-414-9590
Mailing Address - Fax:
Practice Address - Street 1:501 KEISLER DR STE 104
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-9322
Practice Address - Country:US
Practice Address - Phone:919-646-2627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty