1346373644 NPI number — KAREN MICHELLE UNDERWOOD LCMHC

Table of content: KAREN MICHELLE UNDERWOOD LCMHC (NPI 1346373644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346373644 NPI number — KAREN MICHELLE UNDERWOOD LCMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UNDERWOOD
Provider First Name:
KAREN
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HANCOCK
Provider Other First Name:
KAREN
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346373644
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 GOOSE ISLAND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHERRY LOG
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30522-2515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-273-6512
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
91 TIMBERLANE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYNESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28786-7927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-586-5501
Provider Business Practice Location Address Fax Number:
828-837-7468
Provider Enumeration Date:
03/14/2007

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: 101YP2500X , with the licence number:  6880 , 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 © 2007-2024 www.npivalidator.com