1437379922 NPI number — GAIL R FEAGINS LCSW

Table of content: GAIL R FEAGINS LCSW (NPI 1437379922)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437379922 NPI number — GAIL R FEAGINS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FEAGINS
Provider First Name:
GAIL
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1437379922
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
373 CECIL D QUILLEN DR
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
DUFFIELD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24244-4085
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-782-8872
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
373 CECIL D QUILLEN DR
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
DUFFIELD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24244-4085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-431-1638
Provider Business Practice Location Address Fax Number:
276-431-1639
Provider Enumeration Date:
04/26/2007

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:  LSW0000003819 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 0904005085 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 008941041 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00164012 . This is a "RR MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com