Provider Demographics
NPI:1356874036
Name:ATHENA PSYCHOLOGICAL SERVICES PLLC
Entity type:Organization
Organization Name:ATHENA PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST, OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HEURING
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCAS, LPA HSP-PA
Authorized Official - Phone:919-819-5736
Mailing Address - Street 1:9204 FALLS OF NEUSE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2479
Mailing Address - Country:US
Mailing Address - Phone:919-819-5736
Mailing Address - Fax:919-882-1426
Practice Address - Street 1:9204 FALLS OF NEUSE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2479
Practice Address - Country:US
Practice Address - Phone:919-819-5736
Practice Address - Fax:919-882-1426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4887103TA0400X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty