Organization
MLPHENRYDBA DEVELOPMENTAL THERAPY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARGARET LISA PIKE HENRY (CBRS PROVIDER)
(336) 214-2879
Entity
Organization
Contact information
Practice address
7125 BASS MOUNTAIN RD, SNOW CAMP, NC 27349-9167
(336) 214-2879
Mailing address
7125 BASS MOUNTAIN RD, SNOW CAMP, NC 27349-9167
Taxonomy
Speciality
Code
Description
License number
State
251X00000X
Supports Brokerage Agency
Primary
CBRS INFANT TODDLER
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1417091034
NPI- INDIVIDUAL
NC
05
—
8300168
—
NC
05
—
8300168K
—
NC
Enumeration date
09/30/2013
Last updated
10/16/2013
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