Provider Demographics
NPI:1497180855
Name:WORTHINGTON, AUDREY ELIZABETH (PA-C, LCAS, LCMHC)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:ELIZABETH
Last Name:WORTHINGTON
Suffix:
Gender:F
Credentials:PA-C, LCAS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6857
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1090 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7353
Practice Address - Country:US
Practice Address - Phone:910-662-8550
Practice Address - Fax:910-343-1924
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-10465363A00000X, 363A00000X
NC11306101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health