1528077278 NPI number — ELIZABETH MOWLES ERWIN LPC

Table of content: ELIZABETH MOWLES ERWIN LPC (NPI 1528077278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528077278 NPI number — ELIZABETH MOWLES ERWIN LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ERWIN
Provider First Name:
ELIZABETH
Provider Middle Name:
MOWLES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ERWIN
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
MOWLES
Provider Other Name Prefix Text:
PROF.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1528077278
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:
328 MOUNTAIN AVE SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24016-4004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-345-5922
Provider Business Mailing Address Fax Number:
540-345-5712

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
328 MOUNTAIN AVE SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROANOKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24016-4004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-345-5922
Provider Business Practice Location Address Fax Number:
540-345-5712
Provider Enumeration Date:
08/05/2006

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: 101YP2500X , with the licence number:  0701002113 , 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: 086394 . This is a "SENTARA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 077322 . This is a "OPTIONS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7202124 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 045444 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 215379 . This is a "VALUE OPTIONS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5401887 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 209708 . This is a "MANAGED HEALTH NETWORK" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 242378 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: P499628 . This is a "PHCS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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