1447303482 NPI number — MS. JACQUELYN BONITA SHIVERS-ROANE MA, LPC

Table of content: MS. JACQUELYN BONITA SHIVERS-ROANE MA, LPC (NPI 1447303482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447303482 NPI number — MS. JACQUELYN BONITA SHIVERS-ROANE MA, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIVERS-ROANE
Provider First Name:
JACQUELYN
Provider Middle Name:
BONITA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ARRINGTON
Provider Other First Name:
JACQUELYN
Provider Other Middle Name:
BONITA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447303482
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
USAG-GIESSEN
Provider Second Line Business Mailing Address:
CMR 453 BOX 1789
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09074
Provider Business Mailing Address Country Code:
DE
Provider Business Mailing Address Telephone Number:
011496031811710
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
USAG-GIESSEN
Provider Second Line Business Practice Location Address:
CMR 453 BOX 1789
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09074
Provider Business Practice Location Address Country Code:
DE
Provider Business Practice Location Address Telephone Number:
011496031811710
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2007

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:  PRC1193 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YA0400X , with the licence number: ICADC 15184 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





Copyright © 2007-2024 www.npivalidator.com