1982682282 NPI number — MS. VIRGINIA L. HURLEY LCSW

Table of content: (NPI 1558106104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982682282 NPI number — MS. VIRGINIA L. HURLEY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HURLEY
Provider First Name:
VIRGINIA
Provider Middle Name:
L.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HURLEY
Provider Other First Name:
GINGER
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1982682282
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 BAYTREE DR
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:
27858-6107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-258-1944
Provider Business Mailing Address Fax Number:
252-353-4967

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2317 EXECUTIVE CIR
Provider Second Line Business Practice Location Address:
PERSONALIZED THERAPY, INC.
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27834-3762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-353-4968
Provider Business Practice Location Address Fax Number:
252-353-4967
Provider Enumeration Date:
01/06/2006

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: 104100000X , with the licence number:  C000663 , 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: 6002413 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 800013622 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 13293 . This is a "BCBS NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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