Psychotherapeutic Services, Inc | |
2260 S. Church St Suite 303 Burlington NC 27215 | |
(336) 538-6990 | |
(336) 538-6991 |
Full Name | Psychotherapeutic Services, Inc |
---|---|
Speciality | Community/Behavioral Health |
Location | 2260 S. Church St, Burlington, North Carolina |
Authorized Official Name and Position | Marcia Lynn Clendaniel (BILLING MANAGER) |
Authorized Official Contact | 4108102465 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Psychotherapeutic Services, Inc 2260 S Church St Suite 303 Burlington NC 27215 Ph: (410) 778-9114 | Psychotherapeutic Services, Inc 2260 S. Church St Suite 303 Burlington NC 27215 Ph: (336) 538-6990 |
NPI Number | 1649341488 |
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Provider Enumeration Date | 11/13/2006 |
Last Update Date | 07/21/2022 |
Certification Date | 10/22/2020 |
Medicare PECOS PAC ID | 8123032794 |
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Medicare Enrollment ID | O20060202000737 |
Identifier | Type | State | Issuer |
---|---|---|---|
1649341488 | NPI | - | NPPES |
8301699V | Other | NC | GUILFORD CST |
8301181A | Other | NC | PITT ACTT |
8300588A | Other | NC | ASSESSTIVE COMMUNITY TX |
8301699A | Other | NC | GUILFORD ACTT |
3410045 | Medicaid | NC | |
8300588 | Medicaid | NC | |
8300588V | Other | NC | ALAM CST |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TP2701X | Psychologist - Group Psychotherapy | 231369010 (North Carolina) | Secondary |
251S00000X | Community/behavioral Health | (North Carolina) | Primary |
Provider Name | Mohammad D Lateef |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1962445668 PECOS PAC ID: 2264324383 Enrollment ID: I20040325000611 |
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