1114740008 NPI number — MRS. CARLA K HOSKINS LCPC CANDIDATE

Table of content: MRS. CARLA K HOSKINS LCPC CANDIDATE (NPI 1114740008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114740008 NPI number — MRS. CARLA K HOSKINS LCPC CANDIDATE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOSKINS
Provider First Name:
CARLA
Provider Middle Name:
K
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCPC CANDIDATE
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:
1114740008
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 4TH AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST.ALBANS
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25177-2823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-590-5770
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
314 N. LAST CHANCE GULCH
Provider Second Line Business Practice Location Address:
#306
Provider Business Practice Location Address City Name:
HELENA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59601-5062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-209-8268
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2024

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:  BBH-PCLC-LIC-72845 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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