1184702813 NPI number — CHRISTINE SEWARD ALLRED MS, CGC

Table of content: CHRISTINE SEWARD ALLRED MS, CGC (NPI 1184702813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184702813 NPI number — CHRISTINE SEWARD ALLRED MS, CGC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLRED
Provider First Name:
CHRISTINE
Provider Middle Name:
SEWARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, CGC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SEWARD
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
REBECCA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, CGC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1184702813
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13851 PALISADES STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODBRIDGE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22191
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-431-9532
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13851 PALISADES STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODBRIDGE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-431-9532
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2006

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: 170300000X , with the licence number:  2005311 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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