1629340179 NPI number — A PEACE OF MIND COUNSELING PLLC

Table of content: (NPI 1629340179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629340179 NPI number — A PEACE OF MIND COUNSELING PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A PEACE OF MIND COUNSELING PLLC
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:
A PEACE OF MIND COUNSELING
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:
1629340179
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2504 RAEFORD RD
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28305-5294
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-423-9900
Provider Business Mailing Address Fax Number:
910-423-0537

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2504 RAEFORD RD
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28305-5294
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-423-9900
Provider Business Practice Location Address Fax Number:
910-423-0537
Provider Enumeration Date:
01/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
LAWYER
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
PSYCHOTHERAPIST/OWNER
Authorized Official Telephone Number:
910-423-9900

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  C004483 , 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)





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