1982124814 NPI number — CINDY SHEALY, LCSW, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982124814 NPI number — CINDY SHEALY, LCSW, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CINDY SHEALY, LCSW, PA
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:
1982124814
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 TARPON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28806-3122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-505-6946
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
67 CHARLOTTE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28801-2435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-505-6946
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/21/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHEALY
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
SOCIAL WORKER
Authorized Official Telephone Number:
828-505-6946

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  C005171 , 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)