The Gathering Space, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3936 Issued in NC

Legal business name

THE GATHERING SPACE, LLC

Practice address

2216 S Miami Blvd Ste 103
Durham, NC 27703-6284

Phone

(919) 695-3478

NPI assigned

Dec 11, 2015

Last updated

Dec 11, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Amy Lynnae JohnsonNPI 1578759700

Title

Ceo

Phone

(919) 695-3478

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Amy Lynnae Johnson

  • Psychologist
  • Durham, NC
  • NPI 1578759700
  NPD (past) Authorized official

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

{
    "created_epoch": "1449792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449792000000",
    "number": "1841665155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 ELMSFORD ST",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277037874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2216 S MIAMI BLVD STE 103",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277036284",
            "telephone_number": "919-695-3478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE GATHERING SPACE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-11",
        "last_updated": "2015-12-11",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "LYNNAE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "919-695-3478"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "3936",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Durham, NC
• Providers in Durham, NC by specialty
• Clinical Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2015; 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.