1609310226 NPI number — ROBIN R. MINICK

Table of content: (NPI 1609310226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609310226 NPI number — ROBIN R. MINICK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBIN R. MINICK
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:
6
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:
1609310226
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 596
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAYNESVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28786-0596
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-246-9751
Provider Business Mailing Address Fax Number:
182-864-9716

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
66 WALNUT ST
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
WAYNESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28786-3283
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-246-9751
Provider Business Practice Location Address Fax Number:
182-864-9716
Provider Enumeration Date:
12/16/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MINICK
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
LICENSED PROFESSIONAL COUNSELOR
Authorized Official Telephone Number:
828-246-9751

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  8937 , 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: 1144594920 . This is a "INDIVIDUAL NPI NUMBER" identifier . This identifiers is of the category "OTHER".




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