1215078860 NPI number — MRS. BARBARA LYNN WHITLEY L.C.S.W

Table of content: MRS. BARBARA LYNN WHITLEY L.C.S.W (NPI 1215078860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215078860 NPI number — MRS. BARBARA LYNN WHITLEY L.C.S.W

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITLEY
Provider First Name:
BARBARA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
O'BRIEN
Provider Other First Name:
BARBARA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.C.S.W.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215078860
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6708 SANDFIELD CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28304-6028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-987-0840
Provider Business Mailing Address Fax Number:
910-829-1207

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 S MCPHERSON CHURCH RD
Provider Second Line Business Practice Location Address:
SUITE 214
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28303-4974
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-987-0840
Provider Business Practice Location Address Fax Number:
910-829-1207
Provider Enumeration Date:
02/08/2007

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: 1041C0700X , with the licence number:  C001450 , 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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