1801939392 NPI number — MS. MARIANNE KIKTA FOUGERE LICSW

Table of content: MS. MARIANNE KIKTA FOUGERE LICSW (NPI 1801939392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801939392 NPI number — MS. MARIANNE KIKTA FOUGERE LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOUGERE
Provider First Name:
MARIANNE
Provider Middle Name:
KIKTA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
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:
1801939392
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 GRAPEVINE TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27707-5296
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-532-5532
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5850 FAYETTEVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 211
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27713-6289
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-294-8981
Provider Business Practice Location Address Fax Number:
919-999-2497
Provider Enumeration Date:
02/14/2007

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:  C008243 , 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)





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