NPIMap

Organization Active NPI

Conversion Therapeutic Services Inc

  • Home Health Agency
  • Charlotte, NC
National Provider Identifier
1194588616
Registry record updated Oct 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
CONVERSION THERAPEUTIC SERVICES INC
Practice address
11535 Carmel Commons Blvd Ste 102
Charlotte, NC 28226-5314
Phone
(704) 910-1788
NPI assigned
Feb 6, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2024

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

Authorized official

Name
Tenicia Washington, PMHNP, FNP, CRNP
Title
Owner
Phone
(443) 531-1988

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

11535 Carmel Commons Blvd Ste 102
Charlotte, NC 28226-5314

Mailing address

848 Kathy Dianne Dr
Indian Land, SC 29707-6898
Phone (443) 531-1988

National Provider Directory

National Provider Directory
Tax ID family
Conversion Therapeutic Services Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1707177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728345600000",
    "number": "1194588616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "848 KATHY DIANNE DR",
            "city": "INDIAN LAND",
            "state": "SC",
            "postal_code": "297076898",
            "telephone_number": "443-531-1988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11535 CARMEL COMMONS BLVD STE 102",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282265314",
            "telephone_number": "704-910-1788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONVERSION THERAPEUTIC SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-06",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A",
        "authorized_official_last_name": "WASHINGTON",
        "authorized_official_first_name": "TENICIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-531-1988",
        "authorized_official_credential": "PMHNP, FNP, CRNP"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2024; 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.