Provider Demographics
NPI:1215356506
Name:COLLINS, MARY BETH (NCLMBT #9264)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:COLLINS
Suffix:
Gender:F
Credentials:NCLMBT #9264
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509A ERWIN RD
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-4517
Mailing Address - Country:US
Mailing Address - Phone:910-891-9577
Mailing Address - Fax:
Practice Address - Street 1:509A ERWIN RD
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-4517
Practice Address - Country:US
Practice Address - Phone:910-891-9577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9264174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist