1710611322 NPI number — MS. JOY DIANE CARSWELL LCAS-A

Table of content: MS. JOY DIANE CARSWELL LCAS-A (NPI 1710611322)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710611322 NPI number — MS. JOY DIANE CARSWELL LCAS-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARSWELL
Provider First Name:
JOY
Provider Middle Name:
DIANE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCAS-A
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:
1710611322
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 OAK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORGANTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28655-2636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-838-5008
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2415 MORGANTON BLVD SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LENOIR
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28645-9691
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-395-5563
Provider Business Practice Location Address Fax Number:
828-394-5418
Provider Enumeration Date:
07/11/2022

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: 101YA0400X , with the licence number:  LCAS-27934 , 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)