| Southeastpsych Ballantyne, Pllc | |
|
15720 Brixham Hill Ave Ste 150 Charlotte NC 28277-4785 | |
| (704) 970-4791 | |
| (704) 970-4794 |
| Full Name | Southeastpsych Ballantyne, Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 15720 Brixham Hill Ave Ste 150, Charlotte, North Carolina |
| Authorized Official Name and Position | Karen Arrowood Amrhein (DIRECTOR OF FINANCE) |
| Authorized Official Contact | 7045520116 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeastpsych Ballantyne, Pllc 15720 Brixham Hill Ave Ste 150 Charlotte NC 28277-4785 Ph: (704) 970-4791 | Southeastpsych Ballantyne, Pllc 15720 Brixham Hill Ave Ste 150 Charlotte NC 28277-4785 Ph: (704) 970-4791 |
| NPI Number | 1902318249 |
|---|---|
| Provider Enumeration Date | 10/26/2017 |
| Last Update Date | 12/04/2023 |
| Certification Date | 12/04/2023 |
| Medicare PECOS PAC ID | 2264708460 |
|---|---|
| Medicare Enrollment ID | O20171016001129 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902318249 | NPI | - | NPPES |
| Provider Name | Patricia W Vivian |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1528142510 PECOS PAC ID: 0648432989 Enrollment ID: I20120502000232 |
| Provider Name | Jonathan B Feather |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1538243514 PECOS PAC ID: 8123098514 Enrollment ID: I20120508000119 |
| Provider Name | Selena R Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1679096960 PECOS PAC ID: 2264884956 Enrollment ID: I20240118001115 |
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