Conversion Therapeutic Services Inc

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

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

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 4

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

  • Multi-Specialty Clinic/Center
  • Charlotte, NC
  • NPI 1245094192
  NPD tax ID

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": "1295598704",
    "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"
        },
        {
            "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": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 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
• Alexxis S Cook-Graham

• Developmental Disabilities Clinic/Center in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Developmental Disabilities 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.