Provider Demographics
NPI:1639298714
Name:REGIONAL PSYCHIATRY, PLLC
Entity type:Organization
Organization Name:REGIONAL PSYCHIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OUTPATIENT PSYCHIATRY
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DESUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-416-2440
Mailing Address - Street 1:2000 REGENCY PKWY
Mailing Address - Street 2:SUITE 280
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-8506
Mailing Address - Country:US
Mailing Address - Phone:919-238-0008
Mailing Address - Fax:
Practice Address - Street 1:2000 REGENCY PKWY
Practice Address - Street 2:SUITE 280
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-8506
Practice Address - Country:US
Practice Address - Phone:919-238-0008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health