1053749820 NPI number — LINDSEY DALE PHELPS-COPELAND LCSW

Table of content: LINDSEY DALE PHELPS-COPELAND LCSW (NPI 1053749820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053749820 NPI number — LINDSEY DALE PHELPS-COPELAND LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHELPS-COPELAND
Provider First Name:
LINDSEY
Provider Middle Name:
DALE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1053749820
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 669
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AHOSKIE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27910-0669
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-209-0237
Provider Business Mailing Address Fax Number:
252-209-0197

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1850 NC HIGHWAY 11
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURFREESBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27855-9336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-396-0402
Provider Business Practice Location Address Fax Number:
252-396-0401
Provider Enumeration Date:
10/14/2013

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:  C008419 , 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)