Open Space Therapy, PLLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

C003850 Issued in NC

Legal business name

OPEN SPACE THERAPY, PLLC

Practice address

1829 E Franklin St
Suite 100-J
Chapel Hill, NC 27514-5861

Phone

(703) 254-4024

NPI assigned

Sep 26, 2016

Organization subpart

No

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

Authorized official

Name

Susan Potts Kimberly, LCSWNPI 1164709135

Title

Owner

Phone

(703) 254-4024

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Susan Potts Kimberly, LCSW

  • Clinical Social Worker
  • Chapel Hill, NC
  • NPI 1164709135

  NC

  Medicare reassignment NPD Authorized official
• Jennifer Graves, LCSW

  • Clinical Social Worker
  • Durham, NC
  • NPI 1689119869
  NPD (past)
• Lisa Gundersheimer, PHD, LCSW

  • Clinical Social Worker
  • Carrboro, NC
  • NPI 1245361807
  NPD (past)

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

{
    "created_epoch": "1474848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474848000000",
    "number": "1780133223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 SUNSET CREEK CIR",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275164628",
            "telephone_number": "703-254-4024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1829 E FRANKLIN ST",
            "address_2": "SUITE 100-J",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275145861",
            "telephone_number": "703-254-4024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPEN SPACE THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-26",
        "last_updated": "2016-09-26",
        "status": "A",
        "authorized_official_last_name": "KIMBERLY",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "POTTS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-254-4024",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "C003850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valeria Onofrj, MD
• Ngozi Eunice Onoh
• Chinonyerem Andrea Onokalah, MD
• Chinonso Onuoha, MD
• Nino Oo
• Orange County Department on Aging
• Orange Person Chatham MH-DD-Sa Authority
• Joseph Orbaczewski, PT, DPT
• Tanner Marc Orders, MD
• Jaclyn Eugenia Orehova, MD

• All providers in Chapel Hill, NC
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.