1912223934 NPI number — MRS. SHALLY VAID LPC, NCC

Table of content: MRS. SHALLY VAID LPC, NCC (NPI 1912223934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912223934 NPI number — MRS. SHALLY VAID LPC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAID
Provider First Name:
SHALLY
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC, NCC
Provider Gender Code:
F

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:
1912223934
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
02/23/2023
NPI Reactivation Date:
04/25/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
980 BIRMINGHAM RD STE 501-385
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30004-4417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-209-1732
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20116 ASHBROOK PL STE 110120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHBURN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20147-5086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-977-5298
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/15/2010

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: 101YP2500X , with the licence number:  LPC006531 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 0701011923 , 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)