1023303369 NPI number — MRS. SHIRLEY A. BIRD M.A., LPC, LPC#1015

Table of content: MRS. SHIRLEY A. BIRD M.A., LPC, LPC#1015 (NPI 1023303369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023303369 NPI number — MRS. SHIRLEY A. BIRD M.A., LPC, LPC#1015

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIRD
Provider First Name:
SHIRLEY
Provider Middle Name:
A.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., LPC, LPC#1015
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BIRD
Provider Other First Name:
MANDY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCMHC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1023303369
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3620 RUTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIAN TRAIL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28079-7578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-819-3288
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 MATTHEWS MINT HILL RD STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MATTHEWS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28105-2889
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-819-3288
Provider Business Practice Location Address Fax Number:
704-372-1055
Provider Enumeration Date:
06/15/2011

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: 101YM0800X , with the licence number:  1015 , 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)





Copyright © 2007-2025 www.npivalidator.com