Provider Demographics
NPI:1073641825
Name:ALBEMARLE SPEECH & LANGUAGE CTR, LLC
Entity Type:Organization
Organization Name:ALBEMARLE SPEECH & LANGUAGE CTR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HILARY
Authorized Official - Middle Name:AYERS
Authorized Official - Last Name:DIETRICH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, ED, CCC-SLP
Authorized Official - Phone:252-619-5299
Mailing Address - Street 1:309 SELDEN ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-4661
Mailing Address - Country:US
Mailing Address - Phone:252-619-5299
Mailing Address - Fax:252-207-0450
Practice Address - Street 1:309 SELDEN ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4661
Practice Address - Country:US
Practice Address - Phone:252-619-5299
Practice Address - Fax:252-207-0450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4702235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211836Medicaid
NC018Y1OtherBCBS
NC=========OtherTRICARE