NPIMap

Organization Active NPI

Psychotherapeutic Services

  • Group Psychotherapy Psychologist
  • Burlington, NC
National Provider Identifier
1013057009
Registry record updated Dec 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Group Psychotherapy PsychologistTaxonomy code 103TP2701X
Legal business name
PSYCHOTHERAPEUTIC SERVICES
Practice address
2260 S. Church St
Suite 303
Burlington, NC 27215
Phone
(336) 538-6990
Fax
(336) 538-6991
NPI assigned
Feb 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Marcia Lynn Clendaniel
Title
Billing Manager
Phone
(410) 810-2465

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Group Psychotherapy PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TP2701X NC Primary

Addresses

Primary practice location

2260 S. Church St
Suite 303
Burlington, NC 27215

Mailing address

2260 S Church St
Suite 303
Burlington, NC 27215
Phone (410) 778-9114

Other identifiers 2

IdentifierTypeStateIssuer
8300588MedicaidNC
8300588SOtherNCPSYCHOSOCIAL REHAB

National Provider Directory

National Provider Directory
Tax ID family
Psychotherapeutic SVCS44 organizations share this tax ID, including this one

Other organizations with this tax ID 43

Organizations that report the same tax identification number in the National Provider Directory.

View all 43

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480550400000",
    "number": "1013057009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2260 S CHURCH ST",
            "address_2": "SUITE 303",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "27215",
            "telephone_number": "410-778-9114",
            "fax_number": "410-778-7988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2260 S. CHURCH ST",
            "address_2": "SUITE 303",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "27215",
            "telephone_number": "336-538-6990",
            "fax_number": "336-538-6991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOTHERAPEUTIC SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2016-12-01",
        "status": "A",
        "authorized_official_last_name": "CLENDANIEL",
        "authorized_official_first_name": "MARCIA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "410-810-2465"
    },
    "taxonomies": [
        {
            "code": "103TP2701X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300588",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHOSOCIAL REHAB",
            "identifier": "8300588S",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.