Organization
STATE OF NC DIVISION OF HEALTH SERVICES
Active
Organization
STATE OF NC DIVISION OF HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEBORAH E. CARROLLD PH.D. (EARLY INTERVENTION BRANCH HEAD)
(919) 707-5520
Entity
Organization
Contact information
Practice address
1211A IRELAND DR, FAYETTEVILLE, NC 28304-3372
(919) 486-1605
(919) 486-1590
Mailing address
DPH- EARLY INTERVENTION BR, 1916 MAIL SERVICE CENTER, RALEIGH, NC 27699-1916
(919) 707-5520
(919) 870-4834
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13409
BLUE CROSS BLUE SHIELD
NC
05
—
3403412
—
NC
Enumeration date
04/13/2007
Last updated
04/27/2012
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