1164930293 NPI number — MRS. DIANNE HUITT QP,CSAC,NCCPSS

Table of content: MRS. DIANNE HUITT QP,CSAC,NCCPSS (NPI 1164930293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164930293 NPI number — MRS. DIANNE HUITT QP,CSAC,NCCPSS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUITT
Provider First Name:
DIANNE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
QP,CSAC,NCCPSS
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:
1164930293
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2101 TWIN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GASTONIA
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28052-1359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-777-4335
Provider Business Mailing Address Fax Number:
980-251-1088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
176 W FRANKLIN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GASTONIA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28052-4107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-989-3062
Provider Business Practice Location Address Fax Number:
980-251-1088
Provider Enumeration Date:
01/10/2018

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: 101YA0400X , with the licence number:  2967 , 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)





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