1902170293 NPI number — MRS. TAMEIKA LASHOUN IVEY LPC, CPCS, CMAC, NCC

Table of content: MRS. TAMEIKA LASHOUN IVEY LPC, CPCS, CMAC, NCC (NPI 1902170293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902170293 NPI number — MRS. TAMEIKA LASHOUN IVEY LPC, CPCS, CMAC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IVEY
Provider First Name:
TAMEIKA
Provider Middle Name:
LASHOUN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC, CPCS, CMAC, NCC
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:
1902170293
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
114 OAKWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARLEM
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30814-4908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-986-9357
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3643 WALTON WAY EXT
Provider Second Line Business Practice Location Address:
BUILDING 4
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30909-4507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-364-1404
Provider Business Practice Location Address Fax Number:
706-364-1419
Provider Enumeration Date:
03/04/2012

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: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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