1750333852 NPI number — THOMAS E. MCDANIEL, LCSW INC.

Table of content: (NPI 1750333852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750333852 NPI number — THOMAS E. MCDANIEL, LCSW INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS E. MCDANIEL, LCSW INC.
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:
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:
1750333852
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2307
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORGANTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28680-2307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-929-8712
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
276 OLD MOCKSVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
STATESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28625-1949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-929-8712
Provider Business Practice Location Address Fax Number:
704-883-8661
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCDANIEL
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
EVERETT
Authorized Official Title or Position:
PRESIDENT OWNER
Authorized Official Telephone Number:
704-929-8712

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  C003601 , 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: 1952 . This is a "CBHA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2047394 . This is a "CIGNA BHAVIORAL HLTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 126C0 . This is a "BLUE CROSS BLUE SHIELD NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 94892 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 112075 . This is a "UNITED BHAVIORAL HLTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: GRP 358961 PIN366949 . This is a "MANAGE HLTH NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 253003 . This is a "COMPSYCH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 358961 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".




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