1063419158 NPI number — T DIANNE MACPHERSON LCSW, LISW-CP

Table of content: T DIANNE MACPHERSON LCSW, LISW-CP (NPI 1063419158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063419158 NPI number — T DIANNE MACPHERSON LCSW, LISW-CP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACPHERSON
Provider First Name:
T DIANNE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW, LISW-CP
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:
1063419158
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 84
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REIDVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29375-0084
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-585-5021
Provider Business Mailing Address Fax Number:
828-687-6882

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3150 S HIGHWAY 14
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29615-5904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-662-9666
Provider Business Practice Location Address Fax Number:
828-687-6882
Provider Enumeration Date:
07/05/2005

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: 101YA0400X , with the licence number:  CAS 3328 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: LCAS-23423 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: C008226 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 10339 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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