| Self-full Psychotherapy, Pc | |
|
106 Oakley Ave Suite 300 Pineville NC 28134-8620 | |
| (704) 576-3635 | |
| (704) 889-5649 |
| Full Name | Self-full Psychotherapy, Pc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 106 Oakley Ave, Pineville, North Carolina |
| Authorized Official Name and Position | Dorothy Christin Luke (OWNER/PRESIDENT) |
| Authorized Official Contact | 7045763635 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Self-full Psychotherapy, Pc 106 Oakley Ave Suite 300 Pineville NC 28134-8620 Ph: (704) 576-3635 | Self-full Psychotherapy, Pc 106 Oakley Ave Suite 300 Pineville NC 28134-8620 Ph: (704) 576-3635 |
| NPI Number | 1710126412 |
|---|---|
| Provider Enumeration Date | 02/19/2009 |
| Last Update Date | 02/19/2009 |
| Medicare PECOS PAC ID | 8628126786 |
|---|---|
| Medicare Enrollment ID | O20090428000589 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710126412 | NPI | - | NPPES |
| 6002779 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | C004450 (North Carolina) | Primary |
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