Individual
MRS. CAROLYN DIANE PERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
108 STADIUM ST SW, WILSON, NC 27893-4749
(252) 243-7174
(252) 206-7175
Mailing address
108 STADIUM ST SW, P.O. BOX 3054, WILSON, NC 27893-4749
(252) 243-7174
(252) 206-7175
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
098050
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL-098-050
NC
Other
Enumeration date
03/27/2007
Last updated
07/08/2007
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