1629025945 NPI number — MRS. ANN MILLNER HARRELL M.ED.,LPC, NCC, ADTR

Table of content: MRS. ANN MILLNER HARRELL M.ED.,LPC, NCC, ADTR (NPI 1629025945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629025945 NPI number — MRS. ANN MILLNER HARRELL M.ED.,LPC, NCC, ADTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRELL
Provider First Name:
ANN
Provider Middle Name:
MILLNER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED.,LPC, NCC, ADTR
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:
1629025945
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1823 TENNYSON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27410-2440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-282-5972
Provider Business Mailing Address Fax Number:
336-854-0099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
612 PASTEUR DR
Provider Second Line Business Practice Location Address:
STE. 104
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27403-1149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-707-6933
Provider Business Practice Location Address Fax Number:
336-854-0099
Provider Enumeration Date:
05/30/2006

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: 101YP2500X , with the licence number:  3886 , 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: 1321U . This is a "BCBS OF NC PROVIDER ID #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6102081 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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