1144491184 NPI number — MISS FRANTISHKA MCCRIMMON THERAPIST

Table of content: SHAUNTE R BROWN (NPI 1558939645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144491184 NPI number — MISS FRANTISHKA MCCRIMMON THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCRIMMON
Provider First Name:
FRANTISHKA
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
THERAPIST
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:
1144491184
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
241 GRANT STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST END
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27376
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-673-3535
Provider Business Mailing Address Fax Number:
910-673-6565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
241 GRANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST END
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27376-8377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-673-3535
Provider Business Practice Location Address Fax Number:
910-673-6565
Provider Enumeration Date:
03/18/2008

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: C006546 . This is a "LICENSED CLINICAL SOCIAL WORKER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: P004028 . This is a "PROVISIONAL NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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