1366785487 NPI number — MRS. CAROLE LYNNE WESTBROOK LPC

Table of content: MRS. CAROLE LYNNE WESTBROOK LPC (NPI 1366785487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366785487 NPI number — MRS. CAROLE LYNNE WESTBROOK LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WESTBROOK
Provider First Name:
CAROLE
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
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:
1366785487
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2314 LAVISTA WOODS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCKER
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30084-4213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-891-7956
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1830 WATER PL SE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30339-7407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-916-9031
Provider Business Practice Location Address Fax Number:
770-916-9030
Provider Enumeration Date:
03/27/2013

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:  LPC003151 , 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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