1477026144 NPI number — POPE BEHAVIORAL HEALTH AND WELLNESS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477026144 NPI number — POPE BEHAVIORAL HEALTH AND WELLNESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POPE BEHAVIORAL HEALTH AND WELLNESS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1477026144
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 W COLONY PL STE 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27705-7201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-999-7457
Provider Business Mailing Address Fax Number:
919-516-0729

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5102 CHAPEL HILL DURHAM BLVD.
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-999-7457
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/06/2019

Additional Information

Authorized Official

Authorized Official Last Name:
POPE
Authorized Official First Name:
VIRGINIA
Authorized Official Middle Name:
ANNETTE
Authorized Official Title or Position:
MENTAL HEALTH THERAPIST
Authorized Official Telephone Number:
919-999-7457

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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