1518985084 NPI number — CAROLYN ROBIN NOTTINGHAM PHD CLINICAL PSYCHOL

Table of content: CAROLYN ROBIN NOTTINGHAM PHD CLINICAL PSYCHOL (NPI 1518985084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518985084 NPI number — CAROLYN ROBIN NOTTINGHAM PHD CLINICAL PSYCHOL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOTTINGHAM
Provider First Name:
CAROLYN
Provider Middle Name:
ROBIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD CLINICAL PSYCHOL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NOTTINGHAM
Provider Other First Name:
C
Provider Other Middle Name:
ROBIN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1518985084
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6350 CENTER DRIVE
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-227-3072
Provider Business Mailing Address Fax Number:
757-227-3212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6350 CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23502-4107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-227-3072
Provider Business Practice Location Address Fax Number:
757-227-3212
Provider Enumeration Date:
07/17/2006

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: 103T00000X , with the licence number:  0810001991 , 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)





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