Provider Demographics
NPI:1336101393
Name:CODY, CAROL ANN (PHD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:CODY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 QUAIL CIR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-8856
Mailing Address - Country:US
Mailing Address - Phone:704-647-0867
Mailing Address - Fax:
Practice Address - Street 1:7431 114TH AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-5119
Practice Address - Country:US
Practice Address - Phone:800-632-6074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01306103T00000X
NC3817103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6001207Medicaid
MO01306OtherSTATE LICENSE
NC3817OtherLICENSE
MO01306OtherSTATE LICENSE