Provider Demographics
NPI:1295519056
Name:SPARTAN PSYCHOTHERAPY, PLLC
Entity type:Organization
Organization Name:SPARTAN PSYCHOTHERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:SPARTA
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHCA, NCC
Authorized Official - Phone:919-257-9416
Mailing Address - Street 1:45 HOLDING YOUNG RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27596-9254
Mailing Address - Country:US
Mailing Address - Phone:919-257-9416
Mailing Address - Fax:
Practice Address - Street 1:45 HOLDING YOUNG RD
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27596-9254
Practice Address - Country:US
Practice Address - Phone:919-257-9416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-22
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health