Basic Information
| Provider Information | |||||||||
| NPI: | 1467434266 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ATCHLEY | ||||||||
| FirstName: | CLARA | ||||||||
| MiddleName: | HAYNES | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW,LPC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RPLLP | ||||||||
| OtherFirstName: | LIFEWORKS | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | GROUP PRACTICE | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 205 E UNION ST | ||||||||
| Address2: | |||||||||
| City: | MORGANTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286553449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284339190 | ||||||||
| FaxNumber: | 8284339130 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 E UNION ST | ||||||||
| Address2: | |||||||||
| City: | MORGANTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286553449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284339190 | ||||||||
| FaxNumber: | 8284339130 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2005 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 0361 | NC | X | Behavioral Health & Social Service Providers | Counselor | Professional | 1041C0700X | C001109 | NC | X | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 6002821 | 05 | NC | MEDICAID | 2035081 | 01 | NC | CIGNA BEHAVIORAL HEALTH | OTHER | 95161 | 01 | NC | MEDCOST | OTHER | 6292342 | 01 | NC | UNITED BEHAVIORAL | OTHER | 1215A | 01 | NC | BCBS INDIVIDUAL | OTHER |