Basic Information
Provider Information | |||||||||
NPI: | 1831560267 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SNYDER | ||||||||
FirstName: | AUDREY | ||||||||
MiddleName: | LEIGH | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LMHC, LCAS | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | THORNHILL | ||||||||
OtherFirstName: | AUDREY | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 133 E PALMER ST STE 101 | ||||||||
Address2: |   | ||||||||
City: | FRANKLIN | ||||||||
State: | NC | ||||||||
PostalCode: | 287343036 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8283710522 | ||||||||
FaxNumber: | 8286319280 | ||||||||
Practice Location | |||||||||
Address1: | 133 E PALMER ST STE 101 | ||||||||
Address2: |   | ||||||||
City: | FRANKLIN | ||||||||
State: | NC | ||||||||
PostalCode: | 287343036 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8283710522 | ||||||||
FaxNumber: | 8286319280 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/12/2015 | ||||||||
LastUpdateDate: | 09/07/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/07/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | A11875 | NC | N |   | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | A11875 | NC | N |   | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | 11875 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.