1235291675 NPI number — MRS. TELIA YEVETTE VIRGIN L.C.S.W.

Table of content: MRS. TELIA YEVETTE VIRGIN L.C.S.W. (NPI 1235291675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235291675 NPI number — MRS. TELIA YEVETTE VIRGIN L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VIRGIN
Provider First Name:
TELIA
Provider Middle Name:
YEVETTE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TUCKER
Provider Other First Name:
TELIA
Provider Other Middle Name:
YEVETTE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.C.S.W.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235291675
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 WILLOWCROFT CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARNER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27529-7526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-841-3675
Provider Business Mailing Address Fax Number:
919-779-4498

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 WILLOWCROFT CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARNER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27529-7526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-841-3675
Provider Business Practice Location Address Fax Number:
919-779-4498
Provider Enumeration Date:
12/14/2006

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: 1041C0700X , with the licence number:  C005273 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: C005273 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 6106668 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com