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1306386727 NPI number — CHARLENE THEPSIMUONG LCSW

NPI Number: 1306386727
Health Care Provider/Practitioner: CHARLENE THEPSIMUONG LCSW

Information about “1306386727” NPI (CHARLENE THEPSIMUONG LCSW) exists in 1306386727 in HTML format HTML  |  1306386727 in plain Text format TXT  |  1306386727 in PDF (Portable Document Format) PDF  |  1306386727 in an XML format XML  formats.

NPI Number : 1306386727 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1306386727",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "THEPSIMUONG",
    "FirstName": "CHARLENE",
    "MiddleName": null,
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "7211 CLOVERDALE RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ROANOKE",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "24019-8221",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "540-966-5808",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "707 5TH ST NE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ROANOKE",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "24016-2123",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "540-819-3622",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/04/2017",
    "LastUpdateDate": "11/10/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "0904009781",
        "LicenseNumberStateCode": "VA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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