Self-Full Psychotherapy, PC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

C004450 Issued in NC

Legal business name

SELF-FULL PSYCHOTHERAPY, PC

Practice address

106 Oakley Ave
Suite 300
Pineville, NC 28134-8620

Phone

(704) 576-3635

Fax

(704) 889-5649

NPI assigned

Feb 19, 2009

Organization subpart

No

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

Authorized official

Name

Ms. Dorothy Christin Luke, MSW, LCSW

Title

Owner/President

Phone

(704) 576-3635

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1235001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235001600000",
    "number": "1710126412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 OAKLEY AVE",
            "address_2": "SUITE 300",
            "city": "PINEVILLE",
            "state": "NC",
            "postal_code": "281348620",
            "telephone_number": "704-576-3635",
            "fax_number": "704-889-5649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 OAKLEY AVE",
            "address_2": "SUITE 300",
            "city": "PINEVILLE",
            "state": "NC",
            "postal_code": "281348620",
            "telephone_number": "704-576-3635",
            "fax_number": "704-889-5649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF-FULL PSYCHOTHERAPY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-19",
        "last_updated": "2009-02-19",
        "status": "A",
        "authorized_official_last_name": "LUKE",
        "authorized_official_first_name": "DOROTHY",
        "authorized_official_middle_name": "CHRISTIN",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "704-576-3635",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MSW, LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "C004450",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6002779",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Pineville, NC
• Providers in Pineville, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2009; 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.