1336274802 NPI number — MR. THOMAS SPENCER SLAGLE LCSW

Table of content: MR. THOMAS SPENCER SLAGLE LCSW (NPI 1336274802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336274802 NPI number — MR. THOMAS SPENCER SLAGLE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SLAGLE
Provider First Name:
THOMAS
Provider Middle Name:
SPENCER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

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:
1336274802
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 84
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DILLSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28725-0084
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-586-2889
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28734-2925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-627-9254
Provider Business Practice Location Address Fax Number:
828-627-8811
Provider Enumeration Date:
02/23/2007

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:  C001848 , 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)

  • Identifier: 6106004 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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