1174643704 NPI number — BARRETTE WELCH MCFALL MS, CRC, LCAS, LPC

Table of content: BARRETTE WELCH MCFALL MS, CRC, LCAS, LPC (NPI 1174643704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174643704 NPI number — BARRETTE WELCH MCFALL MS, CRC, LCAS, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCFALL
Provider First Name:
BARRETTE
Provider Middle Name:
WELCH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, CRC, LCAS, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WELCH
Provider Other First Name:
BARRETTE
Provider Other Middle Name:
QUINN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174643704
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3705 SAINT MARKS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27707-5010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-606-7537
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3705 SAINT MARKS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27707-5010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-606-7537
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2007

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: 101YA0400X , with the licence number:  1129 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 7026 , 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)

  • Identifier: 6111933 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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