1568908101 NPI number — EMERALD ISLE COUNSELING

Table of content: (NPI 1568908101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568908101 NPI number — EMERALD ISLE COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERALD ISLE COUNSELING
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:
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:
1568908101
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
302 MAGNOLIA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST SIMONS ISLAND
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31522-1346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-268-4750
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 OAK ST
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
ST SIMONS ISLAND
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31522-4738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-268-4750
Provider Business Practice Location Address Fax Number:
888-837-0039
Provider Enumeration Date:
01/06/2017

Additional Information

Authorized Official

Authorized Official Last Name:
ROBB
Authorized Official First Name:
ALLYN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
912-268-4750

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  LPC003181 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1730402207 . This is a "INDIVDULE NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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