Provider Demographics
NPI:1093178519
Name:NORFORD, CAROLYN CARR (ASSISTED LIVING ADMI)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:CARR
Last Name:NORFORD
Suffix:
Gender:F
Credentials:ASSISTED LIVING ADMI
Other - Prefix:DR
Other - First Name:DEREK
Other - Middle Name:C
Other - Last Name:NORFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:5804 BARBELL CIR
Mailing Address - Street 2:
Mailing Address - City:MC LEANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27301-9211
Mailing Address - Country:US
Mailing Address - Phone:336-697-2291
Mailing Address - Fax:
Practice Address - Street 1:5804 BARBELL CIR
Practice Address - Street 2:
Practice Address - City:MC LEANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27301
Practice Address - Country:US
Practice Address - Phone:336-697-2291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA00002603405300000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No405300000XOther Service ProvidersPrevention Professional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1727681OtherNC DEPARTMENT OF THE SECRETARY OF STATE