Provider Demographics
NPI:1144396003
Name:THERAPEUTIC RESOURCE ASSOCIATES PA
Entity type:Organization
Organization Name:THERAPEUTIC RESOURCE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:H
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPA
Authorized Official - Phone:919-247-4750
Mailing Address - Street 1:1618 US HWY ONE NORTH
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27596
Mailing Address - Country:US
Mailing Address - Phone:919-247-4750
Mailing Address - Fax:919-562-9917
Practice Address - Street 1:1618 US HWY 1 NORTH
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27596-9219
Practice Address - Country:US
Practice Address - Phone:919-247-4750
Practice Address - Fax:919-562-9917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2472103T00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC139THOtherBCBS
NC6107175Medicaid
NC6005851Medicaid