1740400415 NPI number — IRINA ORLOVA MCKEITHAN M.A., LPC

Table of content: IRINA ORLOVA MCKEITHAN M.A., LPC (NPI 1740400415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740400415 NPI number — IRINA ORLOVA MCKEITHAN M.A., LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCKEITHAN
Provider First Name:
IRINA
Provider Middle Name:
ORLOVA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ORLOVA
Provider Other First Name:
IRINA
Provider Other Middle Name:
Y
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740400415
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
158 E MELISSA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOREST CITY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28043-8774
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-607-4376
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
182 W COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUTHERFORDTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28139-2805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-287-7806
Provider Business Practice Location Address Fax Number:
828-287-0004
Provider Enumeration Date:
04/26/2007

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: 101YM0800X , with the licence number:  6929 , 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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