1437390077 NPI number — LEE HASTY, LCSW, PA

Table of content: (NPI 1437390077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437390077 NPI number — LEE HASTY, LCSW, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEE HASTY, LCSW, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437390077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2649 BREKONRIDGE CENTRE DR
Provider Second Line Business Mailing Address:
SUITE 112
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28110-5631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-283-2900
Provider Business Mailing Address Fax Number:
704-283-2977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2649 BREKONRIDGE CENTRE DR
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28110-5631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-283-2900
Provider Business Practice Location Address Fax Number:
704-283-2977
Provider Enumeration Date:
03/11/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HASTY
Authorized Official First Name:
LEE
Authorized Official Middle Name:
MCNAIR
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
704-283-2900

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  COOO488 , 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: 6002308 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com