| The Gathering Space, Llc | |
|
2216 S Miami Blvd Ste 103 Durham NC 27703-6284 | |
| (919) 695-3478 | |
| Not Available |
| Full Name | The Gathering Space, Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 2216 S Miami Blvd Ste 103, Durham, North Carolina |
| Authorized Official Name and Position | Amy Lynnae Johnson (CEO) |
| Authorized Official Contact | 9196953478 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Gathering Space, Llc 112 Elmsford St Durham NC 27703-7874 Ph: () - | The Gathering Space, Llc 2216 S Miami Blvd Ste 103 Durham NC 27703-6284 Ph: (919) 695-3478 |
| NPI Number | 1841665155 |
|---|---|
| Provider Enumeration Date | 12/11/2015 |
| Last Update Date | 12/11/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841665155 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 3936 (North Carolina) | Primary |
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