Provider Demographics
NPI:1740459544
Name:CENTER FOR PSYCHOTHERAPY AND LIFE SKILLS DEVELOPMENT PA
Entity type:Organization
Organization Name:CENTER FOR PSYCHOTHERAPY AND LIFE SKILLS DEVELOPMENT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:S
Authorized Official - Last Name:METZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:336-274-4669
Mailing Address - Street 1:912 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1513
Mailing Address - Country:US
Mailing Address - Phone:336-274-4669
Mailing Address - Fax:336-274-4749
Practice Address - Street 1:912 N ELM ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1513
Practice Address - Country:US
Practice Address - Phone:336-274-4669
Practice Address - Fax:336-274-4749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001500187103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1073593265Medicare NSC
NC1073593265Medicare UPIN
NC1073593265Medicare Oscar/Certification
NC1073593265Medicare PIN