1043367816 NPI number — DR. STANLEY B ROCKWELL LPC

Table of content: DR. STANLEY B ROCKWELL LPC (NPI 1043367816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043367816 NPI number — DR. STANLEY B ROCKWELL LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROCKWELL
Provider First Name:
STANLEY
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
LPC
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:
1043367816
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2022
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23187-2022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-564-3118
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1313 JAMESTOWN RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
WILLIAMSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23185-3362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-253-1462
Provider Business Practice Location Address Fax Number:
757-253-8061
Provider Enumeration Date:
01/04/2007

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: 101YP2500X , with the licence number:  0701001502 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 153846 . This is a "MAGELLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 360281 . This is a "MANAGED HEALTH NET" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: ANTHEM . This is a "320412" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 004945301 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: O82147 . This is a "OPTIMA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 320411 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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