1558414300 NPI number — MRS. NANCY ANN GEORGES LPC CCAC LSW

Table of content: MRS. NANCY ANN GEORGES LPC CCAC LSW (NPI 1558414300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558414300 NPI number — MRS. NANCY ANN GEORGES LPC CCAC LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEORGES
Provider First Name:
NANCY
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC CCAC LSW
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:
1558414300
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 12 STREET
Provider Second Line Business Mailing Address:
SUITE 303
Provider Business Mailing Address City Name:
WHEELING
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-233-8045
Provider Business Mailing Address Fax Number:
304-233-8085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 12 STREET
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
WHEELING
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-233-8045
Provider Business Practice Location Address Fax Number:
304-233-8085
Provider Enumeration Date:
01/18/2007

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:  98-102 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: AP00940434 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 1279 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Y312145 . This is a "HEALTH PLAN MANAGEMENT" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 98102 . This is a "HORIZON BEHAVIORAL HEALTH" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: WVMX7070 . This is a "ADVANTAGE HEALTH" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: Y312145 . This is a "HEALTH PLAN OF THE UPPER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 001712843 . This is a "BS OF WV MOUNTAIN STATE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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