Provider Demographics
NPI:1902318249
Name:SOUTHEASTPSYCH BALLANTYNE, PLLC
Entity Type:Organization
Organization Name:SOUTHEASTPSYCH BALLANTYNE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ARROWOOD
Authorized Official - Last Name:AMRHEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-552-0116
Mailing Address - Street 1:15720 BRIXHAM HILL AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-4785
Mailing Address - Country:US
Mailing Address - Phone:704-970-4791
Mailing Address - Fax:704-970-4794
Practice Address - Street 1:15720 BRIXHAM HILL AVE STE 150
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4785
Practice Address - Country:US
Practice Address - Phone:704-970-4791
Practice Address - Fax:704-970-4794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-26
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty