1609963420 NPI number — MRS. SHERRI JOHNSON HITCHCOCK LCSW

Table of content: REBECCA TORRES (NPI 1134928823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609963420 NPI number — MRS. SHERRI JOHNSON HITCHCOCK LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HITCHCOCK
Provider First Name:
SHERRI
Provider Middle Name:
JOHNSON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
SHERRI
Provider Other Middle Name:
RENEE'
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609963420
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
116 SPINEL LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNIGHTDALE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27545-7242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-624-6954
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 SPINEL LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KNIGHTDALE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27545-7242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-624-6954
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2006

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:  C006025 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: 11923 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 384854 . This is a "MANAGED HEALTH NETWORK" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 517251 . This is a "UHC MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: LM49EA . This is a "CAREFIRST BCBS GROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 609550002 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 894952-01 . This is a "CAREFIRST BCBS PIN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 259147000 . This is a "MAGELLAN GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 522156095 . This is a "AMERICAN PSYCH SYSTEM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: R968 . This is a "CAREFIRST FEDERAL GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 522156095 . This is a "NCPPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 522156095 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0036 . This is a "CAREFIRST BCBS FEDERAL PI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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