1508190265 NPI number — DR. WILLIE CLARENCE FLEMING PH.D.,LPC, NCC

Table of content: DR. WILLIE CLARENCE FLEMING PH.D.,LPC, NCC (NPI 1508190265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508190265 NPI number — DR. WILLIE CLARENCE FLEMING PH.D.,LPC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLEMING
Provider First Name:
WILLIE
Provider Middle Name:
CLARENCE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.,LPC, NCC
Provider Gender Code:
M

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:
1508190265
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6800 LORETTA PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28215-9716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-563-6158
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1973 JN PEASE PL
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28262-4547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-548-5299
Provider Business Practice Location Address Fax Number:
704-548-5292
Provider Enumeration Date:
09/29/2009

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:  7401 , 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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