1366870933 NPI number — VIRGINIA C. WHITE RN

Table of content: VIRGINIA C. WHITE RN (NPI 1366870933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366870933 NPI number — VIRGINIA C. WHITE RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITE
Provider First Name:
VIRGINIA
Provider Middle Name:
C.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CROWDER
Provider Other First Name:
VIRGINA
Provider Other Middle Name:
GLENN
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:
1366870933
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301-A PALMETTO PARK, BOULEVARD
Provider Second Line Business Mailing Address:
LEXINGTON COUNTY COMMUNITY MENTAL HEALTH CENTER
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-359-3545
Provider Business Mailing Address Fax Number:
803-359-2111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301-A PALMETTO PARK BOULEVARD
Provider Second Line Business Practice Location Address:
LEXINGTON COUNTY COMMUNITY MENTAL HEALTH CENTER
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-359-3545
Provider Business Practice Location Address Fax Number:
803-359-2111
Provider Enumeration Date:
10/17/2013

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: 163WP0809X , with the licence number:  37218 , 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)