1902124993 NPI number — DOVE UNITED COUNSELING AND ASSESSMENT SERVICES

Table of content: (NPI 1902124993)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902124993 NPI number — DOVE UNITED COUNSELING AND ASSESSMENT SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOVE UNITED COUNSELING AND ASSESSMENT 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:
6
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:
1902124993
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 7281
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-258-8045
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
575 S. SQUARE DRIVE
Provider Second Line Business Practice Location Address:
APT 98
Provider Business Practice Location Address City Name:
WINTERVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28590
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-258-8045
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ROBERTS
Authorized Official First Name:
CATHERINE
Authorized Official Middle Name:
ADLANDA
Authorized Official Title or Position:
CLINICAL SUPERVISOR
Authorized Official Telephone Number:
252-258-8045

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  7249 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 1232 , 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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