Provider Demographics
NPI:1255952461
Name:SAFETY HARBOR ASSESSMENT AND THERAPY SERVICES, PLLC
Entity type:Organization
Organization Name:SAFETY HARBOR ASSESSMENT AND THERAPY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PHOLILE
Authorized Official - Middle Name:
Authorized Official - Last Name:DLAMINI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:704-755-5558
Mailing Address - Street 1:20311 CHARTWELL CENTER DR UNIT 196
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-5282
Mailing Address - Country:US
Mailing Address - Phone:704-755-5558
Mailing Address - Fax:704-741-5250
Practice Address - Street 1:18121 W CATAWBA AVE STE 5
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5641
Practice Address - Country:US
Practice Address - Phone:704-755-5558
Practice Address - Fax:704-741-5250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty