1417225301 NPI number — CHRISTINA ARMSTRONG LCSW LLC

Table of content: (NPI 1417225301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417225301 NPI number — CHRISTINA ARMSTRONG LCSW LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTINA ARMSTRONG LCSW LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1417225301
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
85 GOLF CREST DR
Provider Second Line Business Mailing Address:
SUITE 309
Provider Business Mailing Address City Name:
ACWORTH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30101-2698
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-309-8193
Provider Business Mailing Address Fax Number:
770-974-2060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
85 GOLF CREST DR
Provider Second Line Business Practice Location Address:
SUITE 309
Provider Business Practice Location Address City Name:
ACWORTH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30101-2698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-309-8193
Provider Business Practice Location Address Fax Number:
770-974-2060
Provider Enumeration Date:
12/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ARMSTRONG
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER/PRACTITIONER
Authorized Official Telephone Number:
770-309-8193

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CSW002970 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 220502325A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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