Provider Demographics
NPI:1649341488
Name:PSYCHOTHERAPEUTIC SERVICES, INC
Entity type:Organization
Organization Name:PSYCHOTHERAPEUTIC SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CLENDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-810-2465
Mailing Address - Street 1:2260 S CHURCH ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215
Mailing Address - Country:US
Mailing Address - Phone:410-778-9114
Mailing Address - Fax:410-778-7988
Practice Address - Street 1:2260 S. CHURCH ST
Practice Address - Street 2:SUITE 303
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215
Practice Address - Country:US
Practice Address - Phone:336-538-6990
Practice Address - Fax:336-538-6991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC231369010103TP2701X
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301699VOtherGUILFORD CST
NC8301181AOtherPITT ACTT
NC8300588AOtherASSESSTIVE COMMUNITY TX
NC8301699AOtherGUILFORD ACTT
NC3410045Medicaid
NC8300588Medicaid
NC8300588VOtherALAM CST