| Open Space Therapy, Pllc | |
|
1829 E Franklin St Suite 100-j Chapel Hill NC 27514-5861 | |
| (703) 254-4024 | |
| Not Available |
| Full Name | Open Space Therapy, Pllc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1829 E Franklin St, Chapel Hill, North Carolina |
| Authorized Official Name and Position | Susan Potts Kimberly (OWNER) |
| Authorized Official Contact | 7032544024 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Open Space Therapy, Pllc 302 Sunset Creek Cir Chapel Hill NC 27516-4628 Ph: (703) 254-4024 | Open Space Therapy, Pllc 1829 E Franklin St Suite 100-j Chapel Hill NC 27514-5861 Ph: (703) 254-4024 |
| NPI Number | 1780133223 |
|---|---|
| Provider Enumeration Date | 09/26/2016 |
| Last Update Date | 09/26/2016 |
| Medicare PECOS PAC ID | 2769763119 |
|---|---|
| Medicare Enrollment ID | O20161227001141 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780133223 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | C003850 (North Carolina) | Primary |
| Provider Name | Susan P Kimberly |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164709135 PECOS PAC ID: 6204003304 Enrollment ID: I20120112000468 |
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