Provider Demographics
NPI:1093007320
Name:SERAPHIM CHILDREN'S THERAPY
Entity Type:Organization
Organization Name:SERAPHIM CHILDREN'S THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:P
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:828-423-4090
Mailing Address - Street 1:69 WILDFLOWER MOUNTAIN TRL
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-5503
Mailing Address - Country:US
Mailing Address - Phone:828-423-4090
Mailing Address - Fax:828-633-0744
Practice Address - Street 1:69 WILDFLOWER MOUNTAIN TRL
Practice Address - Street 2:
Practice Address - City:CANDLER
Practice Address - State:NC
Practice Address - Zip Code:28715-5503
Practice Address - Country:US
Practice Address - Phone:828-423-4090
Practice Address - Fax:828-633-0744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7269235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412689Medicaid