Provider Demographics
NPI:1992804041
Name:WESTAWAY, PATRICIA R (MA, LCMHC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:R
Last Name:WESTAWAY
Suffix:
Gender:F
Credentials:MA, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3332 BRIDGES ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-3280
Mailing Address - Country:US
Mailing Address - Phone:252-222-0681
Mailing Address - Fax:
Practice Address - Street 1:3332 BRIDGES ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3280
Practice Address - Country:US
Practice Address - Phone:252-222-0681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH470101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH14Y001550NH01OtherBLUE CROSS BLUE SHIELD NH
NH30422352Medicaid