1548424831 NPI number — ALTERNATIVE CREATIVE THERAPY

Table of content: (NPI 1548424831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548424831 NPI number — ALTERNATIVE CREATIVE THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALTERNATIVE CREATIVE THERAPY
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:
1548424831
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 OLD FRANKLIN TPKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKY MOUNT
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24151-5676
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-484-6996
Provider Business Mailing Address Fax Number:
540-484-6935

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 OLD FRANKLIN TPKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKY MOUNT
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24151-5676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-484-6996
Provider Business Practice Location Address Fax Number:
540-484-6935
Provider Enumeration Date:
07/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HODGES
Authorized Official First Name:
SANDI
Authorized Official Middle Name:
GALE
Authorized Official Title or Position:
OWNER/THERAPIST
Authorized Official Telephone Number:
540-484-6996

Provider Taxonomy Codes

  • Taxonomy code: 302F00000X , with the licence number:  0701003548 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 305R00000X , with the licence number: 0701003548 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 305S00000X , with the licence number: 0701003548 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 302R00000X , with the licence number: 0701003548 , 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: 1518643406 . This is a "FAMIS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 11526350 . This is a "CAQH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2117903 . This is a "MAMIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4634562 . This is a "SENTARA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1518943406 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2190356 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 247544 . This is a "SOUTHEASTERN SERVICES" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1518943406 . This is a "VIRGINIA PREMIER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 247544 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 600059283 . This is a "MEGELLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0701003548 . This is a "VIRGINIA STATE BOARD OF COUNSELING" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1332930 . This is a "COMPSYCH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 62-02411 . This is a "UNITED BEHAVIORAL" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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