Individual
MRS. ELIZABETH MCCANN MINES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CTRS,MS
Contact information
Practice address
4810 RAMSEY ST, FAYETTEVILLE, NC 28311-1602
(910) 488-8887
Mailing address
4810 RAMSEY ST, FAYETTEVILLE, NC 28311-1602
(910) 488-8887
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
1510
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1510
LICENSE FOR THERAPY
VA
Enumeration date
11/03/2006
Last updated
07/08/2007
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