1306187075 NPI number — SERGIO ANDRES ARENAS VELASQUEZ LPC, LMHC

Table of content: SERGIO ANDRES ARENAS VELASQUEZ LPC, LMHC (NPI 1306187075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306187075 NPI number — SERGIO ANDRES ARENAS VELASQUEZ LPC, LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARENAS VELASQUEZ
Provider First Name:
SERGIO
Provider Middle Name:
ANDRES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC, LMHC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ARENAS VELASQUEZ
Provider Other First Name:
SERGIO
Provider Other Middle Name:
ANDRES
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1306187075
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9408 COPPER HILL LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28269-0321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-821-2041
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10801 MONROE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MATTHEWS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-237-4240
Provider Business Practice Location Address Fax Number:
704-841-3889
Provider Enumeration Date:
03/06/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  005441 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 13966 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)