Basic Information
| Provider Information | |||||||||
| NPI: | 1841368701 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIDDLETON | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | EDWARD | ||||||||
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| Credential: | MA LPA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 413 OVERLAND TRAIL | ||||||||
| Address2: | |||||||||
| City: | STONEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366277322 | ||||||||
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| Practice Location | |||||||||
| Address1: | 405 NC 65 | ||||||||
| Address2: | |||||||||
| City: | REIDSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363428316 | ||||||||
| FaxNumber: | 3363428352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 0554 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 6107309 | 05 | NC | MEDICAID |