| Extension Training Of Nc, Llc | |
|
700 Morrow Ave Pineville NC 28134-6528 | |
| (919) 592-3608 | |
| (919) 835-9613 |
| Full Name | Extension Training Of Nc, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 700 Morrow Ave, Pineville, North Carolina |
| Authorized Official Name and Position | Christina Lanette Stevenson (OWNER) |
| Authorized Official Contact | 9195923608 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Extension Training Of Nc, Llc 1120 Lombar St Raleigh NC 27610-6499 Ph: (704) 806-2156 | Extension Training Of Nc, Llc 700 Morrow Ave Pineville NC 28134-6528 Ph: (919) 592-3608 |
| NPI Number | 1184143489 |
|---|---|
| Provider Enumeration Date | 09/18/2017 |
| Last Update Date | 09/18/2017 |
| Medicare PECOS PAC ID | 6103218664 |
|---|---|
| Medicare Enrollment ID | O20220113002480 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184143489 | NPI | - | NPPES |
| 5007400 | Other | NC | NURSE PRACTITIONER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 254418 (North Carolina) | Primary |
| Provider Name | Christina Lanette Stevenson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023406329 PECOS PAC ID: 3173842796 Enrollment ID: I20220113002589 |
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