1790709608 NPI number — HAROLD LANDIS SATTERWHITE III LPC

Table of content: AMANDEEP PAL (NPI 1033440441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790709608 NPI number — HAROLD LANDIS SATTERWHITE III LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SATTERWHITE
Provider First Name:
HAROLD
Provider Middle Name:
LANDIS
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
LPC
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:
1790709608
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
284 EXECUTIVE PARK DR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28025-1833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-939-1100
Provider Business Mailing Address Fax Number:
704-939-1173

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 COLVARD ST UNIT 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28640-9797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-246-4542
Provider Business Practice Location Address Fax Number:
336-246-2364
Provider Enumeration Date:
07/26/2006

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:  LCASA-20680 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 3711 , 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: 1790709608 . This is a "UBH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1790709608 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 735162-000 . This is a "MAGELLAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1333E . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1790709608 . This is a "HUMANA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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