Conversion Therapeutic Services Inc

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

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 12, 2024

Organization subpart

No

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

Addresses

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.

• Conversion Therapeutic Services Inc

  • Home Health Agency
  • Charlotte, NC
  • NPI 1194588616
  NPD tax ID
• Conversion Therapeutic Services Inc

  • Developmental Disabilities Clinic/Center
  • Charlotte, NC
  • NPI 1295598704
  NPD tax ID

Locations

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

{
    "created_epoch": "1707696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728345600000",
    "number": "1245094192",
    "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": "2024-02-12",
        "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": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Continuum Wellness LLC
• Convergent Integration Corporation
• Convergent Services Inc
• Converison Therapeutic Service
• Conversion Therapeutic Services Inc
• Conversion Therapeutic Services Inc
• Jill Marie Conway, MD
• John Conway, MSW, LCSWA
• Mary Ellen Smith Conway, LCSW,LMFT,LCAS
• Cook and Associates of North Carolina PLLC

• Multi-Specialty Clinic/Center in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Multi-Specialty Clinic/Center in North Carolina

• 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.