1588857619 NPI number — ALBEMARLE PSYCHOLOGICAL SERVICES

Table of content: (NPI 1588857619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588857619 NPI number — ALBEMARLE PSYCHOLOGICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALBEMARLE PSYCHOLOGICAL SERVICES
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:
1588857619
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 303
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELIZABETH CITY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-338-8821
Provider Business Mailing Address Fax Number:
252-338-6459

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 E CHURCH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETH CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-338-8821
Provider Business Practice Location Address Fax Number:
252-338-6459
Provider Enumeration Date:
08/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ALLEN
Authorized Official First Name:
ROGER
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
252-338-8821

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  NCHSP0954 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103T00000X , with the licence number: NCHSP0956 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 6000148 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 39847 . This is a "OPTIMA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 04098 . This is a "BLUE CROSS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 94483 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 03119 . This is a "BLUE CROSS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6000147 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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