1437207883 NPI number — MS. HEATHER JEAN MASK LPC

Table of content: MS. HEATHER JEAN MASK LPC (NPI 1437207883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437207883 NPI number — MS. HEATHER JEAN MASK LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MASK
Provider First Name:
HEATHER
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAVINESS
Provider Other First Name:
HEATHER
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437207883
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3929 TINSLEY DR STE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGH POINT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27265-1531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-841-4307
Provider Business Mailing Address Fax Number:
336-841-7267

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3929 TINSLEY DR STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGH POINT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27265-1531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-841-4307
Provider Business Practice Location Address Fax Number:
336-841-7267
Provider Enumeration Date:
01/08/2007

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: 101YP2500X , with the licence number:  3894 , 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)

  • Identifier: 182980 . This is a "MEDCOST PROVIDER NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6102968 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7638492 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 242175 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 135NK . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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