1356322481 NPI number — MRS. DONNA ELAINE STROM ED S LPC

Table of content: MRS. DONNA ELAINE STROM ED S LPC (NPI 1356322481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356322481 NPI number — MRS. DONNA ELAINE STROM ED S LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STROM
Provider First Name:
DONNA
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ED S LPC
Provider Gender Code:
F

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:
1356322481
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
419 W MARTINTOWN RD
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
NORTH AUGUSTA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29841-3175
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-640-0679
Provider Business Mailing Address Fax Number:
866-277-2650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
419 W MARTINTOWN RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
NORTH AUGUSTA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29841-3175
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-640-0679
Provider Business Practice Location Address Fax Number:
866-277-2650
Provider Enumeration Date:
11/07/2005

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:  3053 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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