1023659471 NPI number — JESSIE M. ARMSTRONG BSW, SAS, ADC

Table of content: JESSIE M. ARMSTRONG BSW, SAS, ADC (NPI 1023659471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023659471 NPI number — JESSIE M. ARMSTRONG BSW, SAS, ADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARMSTRONG
Provider First Name:
JESSIE
Provider Middle Name:
M.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BSW, SAS, ADC
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:
1023659471
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
199 HERLONG AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCK HILL
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29732-1186
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-323-6856
Provider Business Mailing Address Fax Number:
803-981-6982

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
199 S HERLONG AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCK HILL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-323-6388
Provider Business Practice Location Address Fax Number:
803-323-3831
Provider Enumeration Date:
10/07/2019

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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