1104983980 NPI number — MR. RICHARD M SCHLAUCH JR. MSW, LCSW, LISW-CP

Table of content: MR. RICHARD M SCHLAUCH JR. MSW, LCSW, LISW-CP (NPI 1104983980)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104983980 NPI number — MR. RICHARD M SCHLAUCH JR. MSW, LCSW, LISW-CP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHLAUCH
Provider First Name:
RICHARD
Provider Middle Name:
M
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MSW, LCSW, LISW-CP
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:
1104983980
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1721 EBENEZER RD
Provider Second Line Business Mailing Address:
STE 225
Provider Business Mailing Address City Name:
ROCK HILL
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29732-1119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-329-9639
Provider Business Mailing Address Fax Number:
803-329-5830

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
454 ANDERSON RD S
Provider Second Line Business Practice Location Address:
BTC SUITE #115
Provider Business Practice Location Address City Name:
ROCK HILL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29730-3392
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-329-9639
Provider Business Practice Location Address Fax Number:
803-329-5830
Provider Enumeration Date:
01/02/2007

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: 101YM0800X , with the licence number:  C005197 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 7244 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6106250 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1104983980 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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