1477239432 NPI number — MS. TERRI LYNETTE HOWARD CADC-R

Table of content: MS. TERRI LYNETTE HOWARD CADC-R (NPI 1477239432)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477239432 NPI number — MS. TERRI LYNETTE HOWARD CADC-R

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
HOWARD

Provider First Name:
TERRI

Provider Middle Name:
LYNETTE

Provider Name Prefix Text:
MS.

Provider Name Suffix Text:

Provider Credential Text:
CADC-R

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:
1477239432

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
06/26/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16172 COMMODORE DRIVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:
LANCASTER

Provider Business Mailing Address State Name:
SC

Provider Business Mailing Address Postal Code:
29720

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
704-852-7888

Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 OPTICAL CT NW

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:
CONCORD

Provider Business Practice Location Address State Name:
NC

Provider Business Practice Location Address Postal Code:
28025

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
980-375-1123

Provider Business Practice Location Address Fax Number:
980-985-0672

Provider Enumeration Date:
06/26/2023

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: 101YA0400X , with the licence number: 27898 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Taxonomy code: 101Y00000X , with the licence number: 27898 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .