Individual
MRS. LISSETTE IDA MCENALLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ITFS
Contact information
Practice address
911 BROOKS AVE, GARNER, NC 27529-3812
(919) 819-1738
Mailing address
911 BROOKS AVE, GARNER, NC 27529-3812
(919) 819-1738
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
NC
Other
Enumeration date
07/11/2018
Last updated
07/11/2018
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