1114365665 NPI number — AIMEE MARIE WHALEY LPC

Table of content: AIMEE MARIE WHALEY LPC (NPI 1114365665)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114365665 NPI number — AIMEE MARIE WHALEY LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHALEY
Provider First Name:
AIMEE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WHALEY THOMPSON
Provider Other First Name:
AIMEE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114365665
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
317 MATTHEWS MINT HILL RD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
MATTHEWS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28105-2893
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-879-5483
Provider Business Mailing Address Fax Number:
844-644-5238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
317 MATTHEWS MINT HILL RD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
MATTHEWS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28105-2893
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-879-5483
Provider Business Practice Location Address Fax Number:
844-644-5238
Provider Enumeration Date:
06/06/2013

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:  10252 , 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)

  • Identifier: 32639 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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