Individual
ANPIN NI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1708 OWEN DR, PROFESSIONAL EARLY INTERVENTION SERVICES, FAYETTEVILLE, NC 28304-2830
(984) 244-4773
Mailing address
942 STEWARTS CREEK DR APT 7, FAYETTEVILLE, NC 28314-4100
(984) 244-4773
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
30000650
NC
Other
Enumeration date
05/23/2022
Last updated
06/03/2022
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