Provider Demographics
NPI:1114083128
Name:WEAVER, THURMAN CRAIG (NC CERTIFIED FEE BAS)
Entity Type:Individual
Prefix:
First Name:THURMAN
Middle Name:CRAIG
Last Name:WEAVER
Suffix:
Gender:M
Credentials:NC CERTIFIED FEE BAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 E 5TH STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204
Mailing Address - Country:US
Mailing Address - Phone:704-375-3545
Mailing Address - Fax:704-375-3632
Practice Address - Street 1:509 SEVEN DEVILS ROAD
Practice Address - Street 2:
Practice Address - City:BANNER ELK
Practice Address - State:NC
Practice Address - Zip Code:28604
Practice Address - Country:US
Practice Address - Phone:828-963-2088
Practice Address - Fax:828-963-5778
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9 NC BOARD OF FEE BA103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
BCBS86106OtherBCBS