| Revitalize Psychiatry, Pllc | |
|
11220 Elm Ln Ste 203-9 Charlotte NC 28277-0715 | |
| (704) 459-2181 | |
| (704) 533-9516 |
| Full Name | Revitalize Psychiatry, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 11220 Elm Ln Ste 203-9, Charlotte, North Carolina |
| Authorized Official Name and Position | Casey Watson (OWNER) |
| Authorized Official Contact | 7044592181 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revitalize Psychiatry, Pllc 8022 Providence Rd Ste 500-229 Charlotte NC 28277-9719 Ph: (704) 459-2181 | Revitalize Psychiatry, Pllc 11220 Elm Ln Ste 203-9 Charlotte NC 28277-0715 Ph: (704) 459-2181 |
| NPI Number | 1720792799 |
|---|---|
| Provider Enumeration Date | 01/13/2023 |
| Last Update Date | 04/02/2023 |
| Certification Date | 04/02/2023 |
| Medicare PECOS PAC ID | 4688046378 |
|---|---|
| Medicare Enrollment ID | O20230206002197 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720792799 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Casey Marie Watson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164890281 PECOS PAC ID: 1759688336 Enrollment ID: I20160325000293 |
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