1699944306 NPI number — MRS. KARAN SMITH MONTGOMERY MA, LPC

Table of content: MRS. KARAN SMITH MONTGOMERY MA, LPC (NPI 1699944306)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699944306 NPI number — MRS. KARAN SMITH MONTGOMERY MA, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTGOMERY
Provider First Name:
KARAN
Provider Middle Name:
SMITH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC
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:
1699944306
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 S. HAWTHORNE ROAD
Provider Second Line Business Mailing Address:
SUITE 622 NOVANT HEALTH
Provider Business Mailing Address City Name:
WINSTON-SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27103-3013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-760-4583
Provider Business Mailing Address Fax Number:
336-760-8730

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 S. HAWTHORNE ROAD
Provider Second Line Business Practice Location Address:
SUITE 622 NOVANT HEALTH
Provider Business Practice Location Address City Name:
WINSTON-SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27103-3013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-760-4583
Provider Business Practice Location Address Fax Number:
336-760-8730
Provider Enumeration Date:
02/27/2008

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: 101Y00000X , with the licence number:  LPC 836 , 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)





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