1629260682 NPI number — RICHARD MCCLINTOCK ET AL PTR ALBEMARLE COUNSELING GROUP

Table of content: (NPI 1629260682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629260682 NPI number — RICHARD MCCLINTOCK ET AL PTR ALBEMARLE COUNSELING GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD MCCLINTOCK ET AL PTR ALBEMARLE COUNSELING GROUP
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:
ALBEMARLE COUNSELING GROUP
Provider Other Organization Name Type Code:
3
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:
1629260682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1141 N ROAD ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
ELIZABETH CITY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27909-3354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-335-2018
Provider Business Mailing Address Fax Number:
252-335-9521

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1141 N ROAD ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ELIZABETH CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27909-3354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-335-2018
Provider Business Practice Location Address Fax Number:
252-335-9521
Provider Enumeration Date:
08/14/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCCLINTOCK
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
252-335-2018

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6000047 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".