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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