Basic Information
Provider Information | |||||||||
NPI: | 1861912065 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SCHOONOVER | ||||||||
FirstName: | AUTUMN | ||||||||
MiddleName: | CHRISTINE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1044 DEARBORN CT | ||||||||
Address2: |   | ||||||||
City: | WINTERVILLE | ||||||||
State: | NC | ||||||||
PostalCode: | 285906701 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9193009672 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 350 PEE DEE AVE STE A | ||||||||
Address2: |   | ||||||||
City: | ALBEMARLE | ||||||||
State: | NC | ||||||||
PostalCode: | 280014932 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8662727826 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/20/2017 | ||||||||
LastUpdateDate: | 10/11/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/11/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C012369 | NC | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.