Provider Demographics
NPI:1275702029
Name:LOYDPIERSON, PHILIP (MSW)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:
Last Name:LOYDPIERSON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 STONEYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-3154
Mailing Address - Country:US
Mailing Address - Phone:704-342-3456
Mailing Address - Fax:
Practice Address - Street 1:3214 STONEYBROOK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-3154
Practice Address - Country:US
Practice Address - Phone:704-342-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0016361041C0700X
NC437106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC53118OtherBLUE CROSS/BLUE SHEILD
NC2871679Medicare PIN