Individual
VERNICE DOLORES GALLON CLYBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LRT/CTRS
Contact information
Practice address
126 S ROSE AVE, KANNAPOLIS, NC 28083-3552
(704) 938-9657
Mailing address
126 S ROSE AVE, KANNAPOLIS, NC 28083-3552
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
1702
NC
225800000X
Recreation Therapist
19360
NC
Other
Enumeration date
07/06/2017
Last updated
03/15/2021
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