Provider Demographics
NPI:1831555283
Name:PATTERSON PSYCH GROUP, PLLC
Entity type:Organization
Organization Name:PATTERSON PSYCH GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LEAD CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:BAGWELL
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, ED S, LPCS
Authorized Official - Phone:704-675-0470
Mailing Address - Street 1:1051 R P C RD
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8015
Mailing Address - Country:US
Mailing Address - Phone:704-675-0470
Mailing Address - Fax:866-309-6535
Practice Address - Street 1:1554 UNION RD STE C
Practice Address - Street 2:SUITE 5
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5581
Practice Address - Country:US
Practice Address - Phone:704-675-0470
Practice Address - Fax:855-309-6535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7176101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1861640500OtherNPI