1528197936 NPI number — LINCOLN COUNTY

Table of content: JULIANA TERESA ROZOLSKY LCSW (NPI 1881948362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528197936 NPI number — LINCOLN COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINCOLN COUNTY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1528197936
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
206 GAMBLE DR
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
LINCOLNTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28092-4439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-736-8647
Provider Business Mailing Address Fax Number:
704-732-9033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 GAMBLE DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LINCOLNTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28092-4439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-736-8647
Provider Business Practice Location Address Fax Number:
704-732-9033
Provider Enumeration Date:
03/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HARRINGTON
Authorized Official First Name:
SONJI
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCOUNTANT
Authorized Official Telephone Number:
704-736-8649

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HC0391 , 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)

  • Identifier: 3407054 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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