1861471344 NPI number — ABINGDON CHRISTIAN COUNSELING

Table of content: (NPI 1861471344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861471344 NPI number — ABINGDON CHRISTIAN COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABINGDON CHRISTIAN COUNSELING
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:
WILLIAM B HAYNES JR M ED LPC
Provider Other Organization Name Type Code:
3
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:
1861471344
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1441
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABINGDON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24212-1441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-971-9715
Provider Business Mailing Address Fax Number:
276-739-7926

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
274 PARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ABINGDON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-971-9715
Provider Business Practice Location Address Fax Number:
276-739-7926
Provider Enumeration Date:
01/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAYNES
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
276-971-9715

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  0701001325 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5414601 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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