Healthcare Provider Details

I. General information

NPI: 1003459348
Provider Name (Legal Business Name): CAROLINA THERAPLAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2019
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 PINE WOOD DR
SILER CITY NC
27344-7804
US

IV. Provider business mailing address

90 PINE WOOD DR
SILER CITY NC
27344-7804
US

V. Phone/Fax

Practice location:
  • Phone: 336-906-7350
  • Fax:
Mailing address:
  • Phone: 336-906-7350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LESLIE WILLIAMS
Title or Position: DEVELOPMENTAL THERAPIST
Credential: ITFS
Phone: 336-906-7350