1982790424 NPI number — MELISSA A WILKINS LCSW-C

Table of content: MELISSA A WILKINS LCSW-C (NPI 1982790424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982790424 NPI number — MELISSA A WILKINS LCSW-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILKINS
Provider First Name:
MELISSA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW-C
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:
1982790424
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:
9559 HIGHWIND COURT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-730-6872
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10630 LITTLE PATUXENT PARKWAY
Provider Second Line Business Practice Location Address:
STE 214
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21044-3202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-740-5211
Provider Business Practice Location Address Fax Number:
410-740-0332
Provider Enumeration Date:
10/04/2006

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: 1041C0700X , with the licence number:  05114 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 104100000X , with the licence number: 05114 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 248271 . This is a "MAMSI ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 42273102 . This is a "CAREFIRST MD PLAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 36140007 . This is a "CAREFIRST DC PLAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 725787 . This is a "NCPPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com