1467774083 NPI number — DARLENE ANTHEA MEW LPC MHSP, LCMHC

Table of content: DARLENE ANTHEA MEW LPC MHSP, LCMHC (NPI 1467774083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467774083 NPI number — DARLENE ANTHEA MEW LPC MHSP, LCMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEW
Provider First Name:
DARLENE
Provider Middle Name:
ANTHEA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC MHSP, LCMHC
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:
1467774083
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
748 OVERBRIDGE LN STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37405-3320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-665-6666
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4501 HIXSON PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIXSON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37343-5035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-290-0358
Provider Business Practice Location Address Fax Number:
423-933-2943
Provider Enumeration Date:
02/23/2010

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: 101YP2500X , with the licence number:  LPC0000002542 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X , with the licence number: 19262 , 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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