1588816268 NPI number — DR. ANN BARRIER BONDURANT LPC

Table of content: DR. ANN BARRIER BONDURANT LPC (NPI 1588816268)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588816268 NPI number — DR. ANN BARRIER BONDURANT LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BONDURANT
Provider First Name:
ANN
Provider Middle Name:
BARRIER
Provider Name Prefix Text:
DR.
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:
BONDURANT
Provider Other First Name:
A.
Provider Other Middle Name:
BARRIE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1588816268
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1042 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PULASKI
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24301-5218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-440-3150
Provider Business Mailing Address Fax Number:
540-994-5028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1042 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PULASKI
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24301-5218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-440-3150
Provider Business Practice Location Address Fax Number:
540-994-5028
Provider Enumeration Date:
10/14/2008

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:  0701004448 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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