Provider Demographics
NPI:1841897808
Name:BLUEBIRD AVENUE ART THERAPY AND COUNSELING, PLLC
Entity type:Organization
Organization Name:BLUEBIRD AVENUE ART THERAPY AND COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:JILL
Authorized Official - Last Name:SEITLIN
Authorized Official - Suffix:
Authorized Official - Credentials:ATR-P, LCMHCA
Authorized Official - Phone:704-942-8888
Mailing Address - Street 1:6901 FOLGER DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-5947
Mailing Address - Country:US
Mailing Address - Phone:704-942-7888
Mailing Address - Fax:
Practice Address - Street 1:6901 FOLGER DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-5947
Practice Address - Country:US
Practice Address - Phone:704-942-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health