1982712808 NPI number — MRS. LEPOSAVA LEPA MODIE LCSW

Table of content: MRS. LEPOSAVA LEPA MODIE LCSW (NPI 1982712808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982712808 NPI number — MRS. LEPOSAVA LEPA MODIE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MODIE
Provider First Name:
LEPOSAVA
Provider Middle Name:
LEPA
Provider Name Prefix Text:
MRS.
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:
MODIE
Provider Other First Name:
LEPOSAVA
Provider Other Middle Name:
LEPA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1982712808
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10720 CARMEL COMMONS BLVD STE 320A
Provider Second Line Business Mailing Address:
LEPA MODIE LCSW, PLLC
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28226-3955
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-733-7040
Provider Business Mailing Address Fax Number:
704-552-9588

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10720 CARMEL COMMONS BLVD STE 320A
Provider Second Line Business Practice Location Address:
LEPA MODIE LCSW, PLLC
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28226-3955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-733-7040
Provider Business Practice Location Address Fax Number:
704-552-9588
Provider Enumeration Date:
08/29/2006

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: 1041C0700X , with the licence number:  C004793 , 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: 6003742 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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