1649592940 NPI number — MRS. LORI ANN CONDON LCSW, CADC

Table of content: MRS. LORI ANN CONDON LCSW, CADC (NPI 1649592940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649592940 NPI number — MRS. LORI ANN CONDON LCSW, CADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONDON
Provider First Name:
LORI
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, CADC
Provider Gender Code:
F

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:
1649592940
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 BRITT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENTERPRISE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36330-7881
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-489-4289
Provider Business Mailing Address Fax Number:
334-489-4263

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 ANDREWS AVENUE
Provider Second Line Business Practice Location Address:
CLINICAL SOCIAL WORKER
Provider Business Practice Location Address City Name:
FT. RUCKER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-255-7040
Provider Business Practice Location Address Fax Number:
334-255-7716
Provider Enumeration Date:
02/28/2010

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: 101YA0400X , with the licence number:  154 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 2268C , 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)





Copyright © 2007-2025 www.npivalidator.com