Organization
CAROLINA CHILDREN'S THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA HALES BROGDON M.S.,CCC-SLP (DIRECTOR)
(919) 630-9040
Entity
Organization
Contact information
Practice address
8031 US BUS HWY 70 W, CLAYTON, NC 27520-4807
(919) 630-9040
(919) 553-3836
Mailing address
8031 US BUS HWY 70 W, CLAYTON, NC 27520-4807
(919) 630-9040
(919) 553-3836
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
1468
NC
235Z00000X
Speech-Language Pathologist
3429
NC
235Z00000X
Speech-Language Pathologist
Primary
3916
NC
235Z00000X
Speech-Language Pathologist
5846
NC
235Z00000X
Speech-Language Pathologist
6445
NC
235Z00000X
Speech-Language Pathologist
8686
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011NU
BCBS GROUP PROVIDER NUMBE
NC
05
—
7210782
—
NC
Enumeration date
02/21/2007
Last updated
12/05/2012
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