SOUTHEAST PSYCHOLOGICAL SERVICES PLLC (NPI# 1407090707) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407090707 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST PSYCHOLOGICAL SERVICES PLLC |
| Practice Address |
8840 Blakeney Professional Dr Suite 200 Charlotte NC 28277-6718 |
| Mailing Address |
6115 Park South Dr Suite 130 Charlotte NC 28210-3269 |
| Practice Telephone | 7045520116 |
| Practice Fax Number | 7045527550 |
| Mailing Telephone | 7045520116 |
| Mailing Fax Number | 7045527550 |
| Enumeration Date | 2009-04-30 |
| Last Update Date | 2009-04-30 |
| Authorized Official Name | MRS. JANET H IYOOB (CFO) |
| Authorized Official Telephone | 7045520116 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
5021 | NC | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 6005111 | 05 |
| Street Address |
8840 BLAKENEY PROFESSIONAL DR SUITE 200 |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28277-6718 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245258284 | Gregory Weidner | Internal Medicine | 8840 Blakeney Professional Dr, Ste 100, Charlotte, NC 28277-6718 | 2006-07-17 |
| 1518482322 | Natalie Roberts | Dietitian, Registered | 8840 Blakeney Professional Dr, Suite 100, Charlotte, NC 28277-6718 | 2017-08-14 |
| 1831639509 | Carolinas Physicians Network Inc | Internal Medicine | 8840 Blakeney Professional Dr, Ste 100, Charlotte, NC 28277-6718 | 2017-03-01 |
| 1639622491 | Ryan Michael Kelly | Psychologist | 8840 Blakeney Professional Dr, Suite 200, Charlotte, NC 28277-6718 | 2016-07-28 |
| 1801212048 | Jonathan Hunter Dawson | Dentist | 8840 Blakeney Professional Dr, Charlotte, NC 28277-6718 | 2014-03-12 |
| 1427318294 | Orthocarolina, Pa | Physical Therapist | 8840 Blakeney Professional Dr, Suite 102, Charlotte, NC 28277-6718 | 2012-05-25 |
| 1417266693 | Oweida and Christian Orthopaedics & Sports Med,p.a. | Specialist | 8840 Blakeney Professional Dr, Suite 102, Charlotte, NC 28277-6718 | 2010-10-05 |
| 1790011039 | Tracy Rebekah Dobbins Barcott | Psychologist | 8840 Blakeney Professional Dr, Suite 200, Charlotte, NC 28277-6718 | 2009-10-21 |
| 1861629859 | Joshua S Jensen | Marriage & Family Therapist | 8840 Blakeney Professional Dr, Suite 200, Charlotte, NC 28277-6718 | 2009-06-17 |
| 1356584783 | Jennifer E Mcconnell | Psychologist | 8840 Blakeney Professional Dr, Suite 200, Charlotte, NC 28277-6718 | 2009-04-15 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255949731 | New Life Peer Support and Coaching LLC | Clinic/Center | 3450 Toringdon Way, Suite 200, Charlotte, NC 28277 | 2020-07-21 |
| 1083256762 | Speak Life Counseling Services, Pllc | Counselor | 16147 Lacaster Hwy, Suite 110, Charlotte, NC 28277 | 2019-10-14 |
| 1275010019 | Jigneshkumar R Mistry | Pharmacist | 11805 Allforth Ln Apt 2105, Charlotte, NC 28277 | 2018-07-24 |
| 1255825410 | Novant Medical Group Inc. | Family Medicine | 15033 Balloncroft Parkway, Suite 200, Charlotte, NC 28277 | 2018-06-20 |
| 1447752316 | Harris Teeter LLC | Durable Medical Equipment & Medical Supplies | 11135 Golf Links Dr, Charlotte, NC 28277 | 2018-03-06 |
| 1932607595 | Charlotte Proactive Md PC | Clinic/Center | 11220 Golf Links Drive North, Charlotte, NC 28277 | 2018-01-30 |
| 1003331521 | Accela Spine and Pain, Pllc | Anesthesiology | 10120 Ivey Chase Lane, Apt 617, Charlotte, NC 28277 | 2017-08-04 |
| 1265961619 | Dominicka Whitaker | Counselor | 12365 Bluestem Ln., Charlotte, NC 28277 | 2017-06-08 |
| 1083143408 | Monika D Hayes | Counselor | 11330 Snapfinger Drive, Charlotte, NC 28277 | 2017-06-08 |
| 1225582984 | Danielle Mcdaniel | Occupational Therapist | 5113 Piper Station Dr Ste 103, Charlotte, NC 28277 | 2016-08-11 |
| Find all providers in zip 28277 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770123531 | Robert B Stroker | Psychologist | 10617 Kettering Dr Ste 213, Charlotte, NC 28226-4900 | 2020-01-09 |
| 1902460744 | Holly Hauser | Psychologist | 1905 J N Pease Pl Ste 104, Charlotte, NC 28262-4509 | 2019-04-26 |
| 1972944759 | Intrusted Care Solutions Inc | Psychologist | 2340 N Graham St Ste B, Charlotte, NC 28206-2506 | 2013-07-09 |
| 1790029791 | David E Mermelstein | Psychologist | 6201 Fairview Road, Ste 200, Charlotte, NC 28210-3297 | 2012-11-15 |
| 1598014011 | Jesse Selkin | Psychologist | 8832 Blakeney Professional Dr Ste 105, Charlotte, NC 28277-6717 | 2012-08-30 |
| 1629324975 | Kevin L Gyoerkoe | Psychologist | 8832 Blakeney Professional Dr, Suite 105, Charlotte, NC 28277-6809 | 2012-07-24 |
| 1235406109 | Redlak Recovery Center, Pllc | Psychologist | 10801 Johnston Rd Ste 217, Charlotte, NC 28226-7856 | 2011-11-21 |
| 1801172051 | Chad Wesley Kraska | Psychologist | 7400 Carmel Executive Park Dr Ste 135, Charlotte, NC 28226-8400 | 2011-11-01 |
| 1679805717 | Rose Marie Leday | Psychologist | 3440 Toringdon Way, Suite #205, Charlotte, NC 28277-3190 | 2010-01-29 |
| 1023241965 | Briana Melissa Webber-lind | Psychologist | 12815 Longstraw Rd, Charlotte, NC 28227-3686 | 2009-08-26 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.