1912936402 NPI number — DR. JOHN BENSON ROWE MA, LMFT

Table of content: DR. JOHN BENSON ROWE MA, LMFT (NPI 1912936402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912936402 NPI number — DR. JOHN BENSON ROWE MA, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROWE
Provider First Name:
JOHN
Provider Middle Name:
BENSON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MA, LMFT
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:
1912936402
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4108 PARK RD STE 310
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28209-2261
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-490-4000
Provider Business Mailing Address Fax Number:
704-490-4100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4108 PARK RD STE 310
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28209-2261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-490-4000
Provider Business Practice Location Address Fax Number:
704-490-4100
Provider Enumeration Date:
06/30/2006

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: 106H00000X , with the licence number:  498 , 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: 73517 . This is a "BLUECROSS BLUESHEILD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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