1750654620 NPI number — THOMAS ANTHONY WEATHERS LCAS/LCSW

Table of content: THOMAS ANTHONY WEATHERS LCAS/LCSW (NPI 1750654620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750654620 NPI number — THOMAS ANTHONY WEATHERS LCAS/LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEATHERS
Provider First Name:
THOMAS
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCAS/LCSW
Provider Gender Code:
M

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:
1750654620
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 92
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28332-0092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-876-3228
Provider Business Mailing Address Fax Number:
855-420-6032

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1776 WELLINGTON AVE STE 2
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28403-6075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-799-5452
Provider Business Practice Location Address Fax Number:
855-420-6032
Provider Enumeration Date:
02/22/2012

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:  1984 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: C008509 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1984 . This is a "SUBSTANCE ABUSE PRACTICE BOARD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: C008509 . This is a "NATIONAL ASSOCIATION OF SOCIAL WORKERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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