Healthcare Provider Details

I. General information

NPI: 1700664208
Provider Name (Legal Business Name): CATHY LEE LIVENGOOD BC-HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 SIX FORKS RD STE 120
RALEIGH NC
27615-6260
US

IV. Provider business mailing address

5041 EXECUTIVE DR STE 100
MOREHEAD CITY NC
28557-2507
US

V. Phone/Fax

Practice location:
  • Phone: 919-727-8008
  • Fax: 877-771-3406
Mailing address:
  • Phone: 252-773-0636
  • Fax: 877-771-3406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1664
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: