1205147212 NPI number — MS. MILDRED RUTH CHINAKA MSW, LCSW, MAC, CCJS

Table of content: MS. MILDRED RUTH CHINAKA MSW, LCSW, MAC, CCJS (NPI 1205147212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205147212 NPI number — MS. MILDRED RUTH CHINAKA MSW, LCSW, MAC, CCJS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHINAKA
Provider First Name:
MILDRED
Provider Middle Name:
RUTH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW, MAC, CCJS
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:
1205147212
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 714
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28145-0714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-633-7754
Provider Business Mailing Address Fax Number:
704-633-7754

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
417 NORTH MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE C,CAROLINA COUNSELING SERVICES
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-636-5522
Provider Business Practice Location Address Fax Number:
704-636-5533
Provider Enumeration Date:
06/24/2010

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:  C001631 , 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)





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