1093974537 NPI number — PHOENIX COUNSELING OF GASTON LINCOLN

Table of content: (NPI 1093974537)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093974537 NPI number — PHOENIX COUNSELING OF GASTON LINCOLN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHOENIX COUNSELING OF GASTON LINCOLN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1093974537
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4007 WILD NURSERY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28215-5345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-921-3070
Provider Business Mailing Address Fax Number:
704-921-3066

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
917 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELBY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28150-3958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-921-3070
Provider Business Practice Location Address Fax Number:
704-921-3066
Provider Enumeration Date:
06/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
OLIVER
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
704-921-3070

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , 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