Provider Demographics
NPI:1336191444
Name:PSYCHOLOGICAL HEALTH SERVICES, PC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL HEALTH SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:NEMATI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:336-297-1981
Mailing Address - Street 1:2100 FAIRFAX RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-3009
Mailing Address - Country:US
Mailing Address - Phone:336-297-1981
Mailing Address - Fax:336-297-1983
Practice Address - Street 1:2100 FAIRFAX RD
Practice Address - Street 2:SUITE 208
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3009
Practice Address - Country:US
Practice Address - Phone:336-297-1981
Practice Address - Fax:336-297-1983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2642103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE3524OtherMEDCOST PROVIDER NUMBER
NC1336191444Medicaid
NC6000189Medicaid
NC045HPOtherBCBS PROVIDER NUMBER