Provider Demographics
NPI:1083201289
Name:VIEUX, THALISE (LMBT, MA)
Entity Type:Individual
Prefix:
First Name:THALISE
Middle Name:
Last Name:VIEUX
Suffix:
Gender:F
Credentials:LMBT, MA
Other - Prefix:
Other - First Name:THALISE
Other - Middle Name:
Other - Last Name:VIEUX-MCFARLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMBT, MA
Mailing Address - Street 1:15 MOUNTAINSIDE LN
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-9509
Mailing Address - Country:US
Mailing Address - Phone:910-635-6324
Mailing Address - Fax:
Practice Address - Street 1:15 MOUNTAINSIDE LN
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-9509
Practice Address - Country:US
Practice Address - Phone:910-635-6324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246RP1900X
NC8621225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy