1013113646 NPI number — CLAY COUNTY

Table of content: MARIE NICOLE ULVEN LOWE BCBA (NPI 1386153419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013113646 NPI number — CLAY COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLAY COUNTY
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:
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:
1013113646
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 147
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAYESVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28904-0147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-389-6301
Provider Business Mailing Address Fax Number:
828-389-6427

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
119 COURTHOUSE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAYESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28904-4968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-389-6301
Provider Business Practice Location Address Fax Number:
828-389-6427
Provider Enumeration Date:
06/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOSS
Authorized Official First Name:
REVONDA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR OFFICER
Authorized Official Telephone Number:
828-389-6301

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8700086 . This is a "MEDICAID PROVIDER NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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