1083740989 NPI number — CHARLES R ADCOCK LCSW

Table of content: CHARLES R ADCOCK LCSW (NPI 1083740989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083740989 NPI number — CHARLES R ADCOCK LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADCOCK
Provider First Name:
CHARLES
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

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:
1083740989
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4906 RADFORD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23230-3512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-354-1996
Provider Business Mailing Address Fax Number:
804-354-5516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4906 RADFORD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23230-3512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-354-1996
Provider Business Practice Location Address Fax Number:
804-354-5516
Provider Enumeration Date:
02/26/2007

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: 101YA0400X , with the licence number:  0904002513 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 168467000 . This is a "MAGELLAN MIS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 303526 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 168467000 . This is a "MAGELLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 84904 . This is a "OPTIMA BEHAVIORAL HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 861112647 . This is a "UBH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 145129 . This is a "ANTHEM PROV #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: N06B91 . This is a "EMPIRE PROV #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5608429 . This is a "AETNA PROV #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 102045 . This is a "VALUE OPTION PROV #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1019476 . This is a "CIGNA PROV #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com