1386153948 NPI number — MR. ERICH FREYWALD PRIEST MSW, LCSW

Table of content: MR. ERICH FREYWALD PRIEST MSW, LCSW (NPI 1386153948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386153948 NPI number — MR. ERICH FREYWALD PRIEST MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRIEST
Provider First Name:
ERICH
Provider Middle Name:
FREYWALD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FREYWALD
Provider Other First Name:
ERICH
Provider Other Middle Name:
CHRISTOPHER
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386153948
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2944 BRAMBLEWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEBANE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27302-9215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-639-8976
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2944 BRAMBLEWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEBANE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27302-9215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-639-8976
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2017

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:  C012901 , 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)





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