1265733521 NPI number — MRS. CHRISTINA V. CLARK LPC, NCC

Table of content: MRS. CHRISTINA V. CLARK LPC, NCC (NPI 1265733521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265733521 NPI number — MRS. CHRISTINA V. CLARK LPC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLARK
Provider First Name:
CHRISTINA
Provider Middle Name:
V.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC, NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLARK
Provider Other First Name:
TINA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1265733521
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2003
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SKYLAND
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28776-2003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-681-2837
Provider Business Mailing Address Fax Number:
828-681-2837

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 ARLINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28801-2006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-681-2837
Provider Business Practice Location Address Fax Number:
828-681-2837
Provider Enumeration Date:
11/03/2010

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: 101Y00000X , with the licence number:  7926 , 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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