1427208362 NPI number — LISA B CREEF LCSW, PC

Table of content: (NPI 1427208362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427208362 NPI number — LISA B CREEF LCSW, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LISA B CREEF LCSW, PC
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:
1427208362
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 188
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH MILLS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27976-0188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-335-5346
Provider Business Mailing Address Fax Number:
252-335-5365

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1241 B NORTH ROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETH CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27909-3335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-335-5346
Provider Business Practice Location Address Fax Number:
252-335-5365
Provider Enumeration Date:
09/29/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CREEF
Authorized Official First Name:
LISA
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
252-335-5346

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  C006138 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: 0904001497 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 332387 . This is a "BC/BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 6007190 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8909725 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".