1770638819 NPI number — SHERRY ET EL COUNSELING SERVICES

Table of content: (NPI 1770638819)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770638819 NPI number — SHERRY ET EL COUNSELING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHERRY ET EL COUNSELING SERVICES
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:
1770638819
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 54
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISBURG
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27549-0054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-340-0230
Provider Business Mailing Address Fax Number:
919-340-2300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 W NASH ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LOUISBURG
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27549-2526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-340-0230
Provider Business Practice Location Address Fax Number:
919-340-2300
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TABRON
Authorized Official First Name:
SHERRY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
919-340-0230

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  C001710 , 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)

  • Identifier: 016WH . This is a "BLUE CROSS BLUE SHIELD NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 362112 . This is a "MHN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6005188 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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