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NPI Code Detail

MEDICARE: DR. DONNA EILEEN THACKWRAY PHD

MEDICARE: DR. DONNA EILEEN THACKWRAY PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist1769NC

General Provider Information

NPI Number : 1669534434
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DONNA EILEEN THACKWRAY PHD
Provider Business Mailing Address
First Line : 220 W UNION ST
Second Line :
City : MORGANTON
State : NC
Zip : 28655-3764
Country : US
Telephone Number : 828-437-0755
Fax Number :
Provider Business Practice Location Address
First Line : 220 W UNION ST
Second Line :
City : MORGANTON
State : NC
Zip : 28655-3764
Country : US
Telephone Number : 828-437-0755
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2006
Last Update Date : 07/08/2007

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