1265511109 NPI number — MRS. AREFEH PARTOVI LANGKILDE LPC EDS

Table of content: MRS. AREFEH PARTOVI LANGKILDE LPC EDS (NPI 1265511109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265511109 NPI number — MRS. AREFEH PARTOVI LANGKILDE LPC EDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANGKILDE
Provider First Name:
AREFEH
Provider Middle Name:
PARTOVI
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC EDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LANGKILDE
Provider Other First Name:
AREFEH
Provider Other Middle Name:
P
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ED.S.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1265511109
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:
PO BOX 73
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINSTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30187
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-489-2415
Provider Business Mailing Address Fax Number:
770-489-2568

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8309 C OFFICE PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOUGLASVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-489-2415
Provider Business Practice Location Address Fax Number:
770-489-2568
Provider Enumeration Date:
11/02/2006

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: 101YP2500X , with the licence number:  1822 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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