1598858003 NPI number — SHIRILL H. BINES LPCS

Table of content: SHIRILL H. BINES LPCS (NPI 1598858003)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598858003 NPI number — SHIRILL H. BINES LPCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BINES
Provider First Name:
SHIRILL
Provider Middle Name:
H.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPCS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HICKS
Provider Other First Name:
SHIRILL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598858003
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PSC 3 BOX 1754
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09021-0018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-218-3086
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNIT 33100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09180-3100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-218-3086
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2006

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:  5201S , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6103209 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1013025873 . This is a "MENTAL HEALTH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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