1376998815 NPI number — MRS. PAULETTE COTHREN WINGARD LMSW

Table of content: MRS. PAULETTE COTHREN WINGARD LMSW (NPI 1376998815)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376998815 NPI number — MRS. PAULETTE COTHREN WINGARD LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WINGARD
Provider First Name:
PAULETTE
Provider Middle Name:
COTHREN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COTHREN
Provider Other First Name:
LILLIAN
Provider Other Middle Name:
PAULETTE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376998815
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 39
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLYWOOD
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29449-0039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-889-3462
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7783 MORRIS BING RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29449-5993
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-889-3462
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2016

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:  2551 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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