SOUTHEAST PSYCHOLOGICAL SERVICES PLLC
NPI 1407090707
Psychologist - Clinical in Charlotte, NC
NPI Status: Active since April 30, 2009
Contact Information
8840 BLAKENEY PROFESSIONAL DR
SUITE 200
CHARLOTTE, NC
ZIP 28277
Phone: (704) 552-0116
Fax: (704) 552-7550
- Organization
- Psychologist
- Clinical
- CLIA Number: 34D2115652
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 04-16-2027
About SOUTHEAST PSYCHOLOGICAL SERVICES PLLC
This page provides the complete NPI Profile along with additional information for Southeast Psychological Services Pllc, a provider established in Charlotte, North Carolina operating as a Psychologist, focusing in clinical . The healthcare provider is registered in the NPI registry with number 1407090707 assigned on April 2009. The practitioner's primary taxonomy code is 103TC0700X with license number 5021 (NC). The provider is registered as an organization and their NPI record was last updated 17 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The authorized official of this NPI record is Mrs. Janet H Iyoob (Cfo)
- NPI
- 1407090707
- Provider Name
- SOUTHEAST PSYCHOLOGICAL SERVICES PLLC
- Entity Type
- Organization
- Location Address
- 8840 BLAKENEY PROFESSIONAL DR SUITE 200 CHARLOTTE, NC 28277
- Location Phone
- (704) 552-0116
- Location Fax
- (704) 552-7550
- Mailing Address
- 6115 PARK SOUTH DR SUITE 130 CHARLOTTE, NC 28210
- Mailing Phone
- (704) 552-0116
- Mailing Fax
- (704) 552-7550
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 04-30-2009
- Last Update Date
- 04-30-2009
- Code Navigator
A clinical psychologist like Southeast Psychological Services Pllc assesses, diagnoses, and treats mental, emotional, and behavioral disorders. Clinical psychologists help people deal with problems ranging from short-term personal issues to severe, chronic conditions. Clinical psychologists interview patients, give diagnostic tests, provide psychotherapy and design behavior modification programs to help patients.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Psychologist Clinical
- Taxonomy Code
- 103TC0700X
- Type
- Behavioral Health & Social Service Providers
- License No.
- 5021
- License State
- NC
- Taxonomy Description
- A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 6005111 | MEDICAID (05) | NC | |
| 2819904 | MEDICARE PIN (08) | NC |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 34D2115652
- Facility Type
- Physician Office
- Certificate Effective Date
- April 17, 2025
- Certificate Expiration Date
- April 16, 2027
- Laboratory Director
- DR. JOSEPH G. KEENAN
- Certificate Type
- Certificate of Accreditation
- Certificate Type Description
- This is a CLIA certificate is issued to Southeast Psychological Services Pllc on the basis of the laboratory's accreditation by an accreditation organization approved by CMS. This type of certificate is issued to a laboratories tha perform nonwaived (moderate and/or high complexity) testing.
Reviews for SOUTHEAST PSYCHOLOGICAL SERVICES PLLC
There are currently no reviews for this provider. Be the first person to share your experience with this provider by filling out our review form. Your insights are appreciated and will help others make informed decisions.
NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1407090707, we treat the final digit (7) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 53. The final step is to find the difference between that total and the next multiple of ten (60 - 53 = 7).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 53 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 9 providers are registered at the same or a nearby location.
CHARLOTTE, NC 28277
CHARLOTTE, NC 28277
CHARLOTTE, NC 28277
CHARLOTTE, NC 28277
CHARLOTTE, NC 28277
CHARLOTTE, NC 28277
CHARLOTTE, NC 28277
CHARLOTTE, NC 28277
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1407090707, enumerated as an "organization" on April 30, 2009.
The provider is located at 8840 BLAKENEY PROFESSIONAL DR SUITE 200 CHARLOTTE, NC 28277 and the phone number is (704) 552-0116.
Psychologist with taxonomy code 103TC0700X and a focus in Clinical.
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
