1285971374 NPI number — CATAWBA VALLEY PSYCHOLOGICAL ASSOCIATES

Table of content: (NPI 1285971374)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285971374 NPI number — CATAWBA VALLEY PSYCHOLOGICAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATAWBA VALLEY PSYCHOLOGICAL ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1285971374
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 BROWNING DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAYLORSVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28681-6642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-848-8278
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211-B HIGHWAY 127 S.E., SUITE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HICKORY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28602-3541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-848-8278
Provider Business Practice Location Address Fax Number:
828-270-7868
Provider Enumeration Date:
01/09/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SHANNON-KIRBY
Authorized Official First Name:
ROBERTA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PROPRIETOR
Authorized Official Telephone Number:
828-848-8278

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X , with the licence number:  3679 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 3679 , 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)





Copyright © 2007-2025 www.npivalidator.com