Provider Demographics
NPI:1386181576
Name:EPHRAIM, TOREIA
Entity Type:Individual
Prefix:
First Name:TOREIA
Middle Name:
Last Name:EPHRAIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 BAREFOOT RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-8220
Mailing Address - Country:US
Mailing Address - Phone:910-884-5543
Mailing Address - Fax:910-248-6524
Practice Address - Street 1:317 BAREFOOT RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-8220
Practice Address - Country:US
Practice Address - Phone:910-884-5443
Practice Address - Fax:910-248-6524
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC81-5093850OtherEIN