1801185350 NPI number — DIVINE BEHAVIORAL HEALTH SOLUTIONS L.L.C.

Table of content: LINDSAY KATHLEEN DICKERSON MD (NPI 1295279776)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801185350 NPI number — DIVINE BEHAVIORAL HEALTH SOLUTIONS L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIVINE BEHAVIORAL HEALTH SOLUTIONS L.L.C.
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:
1801185350
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5500 FORTUNES RIDGE DR
Provider Second Line Business Mailing Address:
74B
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27713-9365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-602-7525
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6015 FAYETTEVILLE RD
Provider Second Line Business Practice Location Address:
STE 114
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27713-6254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-602-7525
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MOHAMMED
Authorized Official First Name:
HAKEEM
Authorized Official Middle Name:
LEKAN
Authorized Official Title or Position:
CHIEF BUSINESS MANAGER
Authorized Official Telephone Number:
336-602-7525

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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