1588263438 NPI number — ALECIA VICTORIA MITIGUY MSW, LCSW-A

Table of content: ALECIA VICTORIA MITIGUY MSW, LCSW-A (NPI 1588263438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588263438 NPI number — ALECIA VICTORIA MITIGUY MSW, LCSW-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITIGUY
Provider First Name:
ALECIA
Provider Middle Name:
VICTORIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NICKERSON
Provider Other First Name:
ALECIA
Provider Other Middle Name:
VICTORIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588263438
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
287 SHADOWBARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARNER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27529-6654
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-417-4176
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 HIGHWOODS BLVD STE 310
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27604-1029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-504-6338
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/21/2020

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:  P014773 , 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)





Copyright © 2007-2024 www.npivalidator.com