1013034578 NPI number — WANDA CAPPS STOVALL LCSW

Table of content: WANDA CAPPS STOVALL LCSW (NPI 1013034578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013034578 NPI number — WANDA CAPPS STOVALL LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOVALL
Provider First Name:
WANDA
Provider Middle Name:
CAPPS
Provider Name Prefix Text:
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:
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:
1013034578
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10414
Provider Second Line Business Mailing Address:
C O PARADIGM HEALTH SERVICES
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33773-0414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3125 POPLARWOOD CT
Provider Second Line Business Practice Location Address:
ASPEN BLDG., SUITE 100
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27604-1084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-632-6074
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/22/2007

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:  C002955 , 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: 6003453 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00069705 . This is a "RR MCARE W PARADIGM 84" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".