1538642400 NPI number — DAILEY ANN CHAMPION MASON LPC-A, NCC, M.ED.

Table of content: DAILEY ANN CHAMPION MASON LPC-A, NCC, M.ED. (NPI 1538642400)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538642400 NPI number — DAILEY ANN CHAMPION MASON LPC-A, NCC, M.ED.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MASON
Provider First Name:
DAILEY
Provider Middle Name:
ANN CHAMPION
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC-A, NCC, M.ED.
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:
1538642400
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
284 EXECUTIVE PARK DR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28025-1833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-939-1100
Provider Business Mailing Address Fax Number:
704-939-1173

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1105 E CARDINAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILER CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27344-3300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-663-2955
Provider Business Practice Location Address Fax Number:
919-799-7713
Provider Enumeration Date:
09/07/2018

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 , with the licence number:  A14283 , 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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