Provider Demographics
NPI:1649071960
Name:PSYCHIATRYSPACE, PC
Entity type:Organization
Organization Name:PSYCHIATRYSPACE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-250-6776
Mailing Address - Street 1:19 PAVILION LAKE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29860-7520
Mailing Address - Country:US
Mailing Address - Phone:540-204-8111
Mailing Address - Fax:
Practice Address - Street 1:410 UNIVERSITY PARKWAY
Practice Address - Street 2:SUITE 2300
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6807
Practice Address - Country:US
Practice Address - Phone:540-250-6776
Practice Address - Fax:540-382-1517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-22
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty