| Brain Spot Pllc | |
|
1939 Tate Blvd Se Hickory NC 28602-1430 | |
| (828) 475-2407 | |
| Not Available |
| Full Name | Brain Spot Pllc |
|---|---|
| Speciality | Counselor |
| Location | 1939 Tate Blvd Se, Hickory, North Carolina |
| Authorized Official Name and Position | Kenneth Doyle (OWNER) |
| Authorized Official Contact | 8284233356 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brain Spot Pllc 1939 Tate Blvd Se Hickory NC 28602-1430 Ph: (828) 475-2407 | Brain Spot Pllc 1939 Tate Blvd Se Hickory NC 28602-1430 Ph: (828) 475-2407 |
| NPI Number | 1912774993 |
|---|---|
| Provider Enumeration Date | 12/08/2023 |
| Last Update Date | 03/18/2024 |
| Certification Date | 03/18/2024 |
| Medicare PECOS PAC ID | 8921458142 |
|---|---|
| Medicare Enrollment ID | O20231229000590 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912774993 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Secondary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Kenneth Doyle |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1003411026 PECOS PAC ID: 9830549054 Enrollment ID: I20231229000724 |
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