1598110702 NPI number — CHESBROUGH LAWING ROBERTS M.S, LPC

Table of content: CHESBROUGH LAWING ROBERTS M.S, LPC (NPI 1598110702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598110702 NPI number — CHESBROUGH LAWING ROBERTS M.S, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTS
Provider First Name:
CHESBROUGH
Provider Middle Name:
LAWING
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAWING
Provider Other First Name:
NANCY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S, LPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1598110702
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2102 CAHABA RD
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
MOUNTAIN BRK
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35223-1161
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-835-7173
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2102 CAHABA RD
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
MOUNTAIN BRK
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35223-1161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-835-7173
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2016

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: 101YP2500X , with the licence number:  3536 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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