Provider Demographics
NPI:1538735634
Name:ASENCIO THERAPEUTIC SERVICES, PLLC
Entity type:Organization
Organization Name:ASENCIO THERAPEUTIC SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:RHEA
Authorized Official - Last Name:RONDEL ASENCIO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:704-672-0578
Mailing Address - Street 1:318 HILLANDALE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-0994
Mailing Address - Country:US
Mailing Address - Phone:734-972-8970
Mailing Address - Fax:
Practice Address - Street 1:7810 BALLANTYNE COMMONS PKWY STE 222
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3416
Practice Address - Country:US
Practice Address - Phone:704-672-0578
Practice Address - Fax:704-672-0726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty