1538244793 NPI number — MRS. LEAH SHEA WITENBARGER LPC, NCC

Table of content: MRS. LEAH SHEA WITENBARGER LPC, NCC (NPI 1538244793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538244793 NPI number — MRS. LEAH SHEA WITENBARGER LPC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WITENBARGER
Provider First Name:
LEAH
Provider Middle Name:
SHEA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC, NCC
Provider Gender Code:
F

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:
1538244793
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
370 MOSS PINK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VASS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28394-8412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-690-8183
Provider Business Mailing Address Fax Number:
910-491-9631

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 N PAGE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINEHURST
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-690-8183
Provider Business Practice Location Address Fax Number:
910-491-9631
Provider Enumeration Date:
10/26/2006

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: 101Y00000X , with the licence number:  5364 , 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: 6103281 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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