1780269738 NPI number — MRS. MISTIE SUE MCPADALIN LCSW

Table of content: MRS. MISTIE SUE MCPADALIN LCSW (NPI 1780269738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780269738 NPI number — MRS. MISTIE SUE MCPADALIN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCPADALIN
Provider First Name:
MISTIE
Provider Middle Name:
SUE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1780269738
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
503 GARDEN GATE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STEPHENS CITY
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22655-5347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-660-0567
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WINCHESTER MEDICAL CENTER
Provider Second Line Business Practice Location Address:
1840 AMHERST STREET
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-536-5191
Provider Business Practice Location Address Fax Number:
540-536-3266
Provider Enumeration Date:
03/11/2021

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: 1041C0700X , with the licence number:  0904006720 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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