1780794586 NPI number — DR. LLOYD WILLIAM MITCHAM JR. LMFT

Table of content: DR. LLOYD WILLIAM MITCHAM JR. LMFT (NPI 1780794586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780794586 NPI number — DR. LLOYD WILLIAM MITCHAM JR. LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCHAM
Provider First Name:
LLOYD
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
LMFT
Provider Gender Code:
M

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:
1780794586
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1426 REDMON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28658-8490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-464-7580
Provider Business Mailing Address Fax Number:
828-464-1879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1375 LENOIR RHYNE BLVD SE
Provider Second Line Business Practice Location Address:
PIEDMONT CENTER SUITE 122
Provider Business Practice Location Address City Name:
HICKORY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28602-5171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-328-8808
Provider Business Practice Location Address Fax Number:
828-464-1879
Provider Enumeration Date:
08/30/2006

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: 106H00000X , with the licence number:  420 , 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)





Copyright © 2007-2024 www.npivalidator.com