1093450462 NPI number — MAUDELINE CLERVOIX-FRANK LCMHCA, LCASA

Table of content: MAUDELINE CLERVOIX-FRANK LCMHCA, LCASA (NPI 1093450462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093450462 NPI number — MAUDELINE CLERVOIX-FRANK LCMHCA, LCASA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLERVOIX-FRANK
Provider First Name:
MAUDELINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCMHCA, LCASA
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:
1093450462
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8620 ENGLISH SADDLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28314-6069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
929-270-2137
Provider Business Mailing Address Fax Number:
910-824-7593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8620 ENGLISH SADDLE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28314-6069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
929-270-2137
Provider Business Practice Location Address Fax Number:
910-824-7593
Provider Enumeration Date:
04/30/2022

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:  A18506 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YA0400X , with the licence number: LCAS-28787 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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