Individual
DEBORAH FAIRCLOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
851 OUTLAW RD, DUDLEY, NC 28333-8145
(910) 290-0291
Mailing address
PO BOX 157, WARSAW, NC 28398-0157
(910) 290-0291
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8302553
—
NC
Enumeration date
02/04/2009
Last updated
03/25/2009
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