Provider Demographics
NPI:1558541219
Name:THAMES, EVELYN WHITE
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:WHITE
Last Name:THAMES
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 1:9407 PASTERN CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-1761
Mailing Address - Country:US
Mailing Address - Phone:704-779-2663
Mailing Address - Fax:704-597-3734
Practice Address - Street 1:9407 PASTERN CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-1761
Practice Address - Country:US
Practice Address - Phone:704-779-2663
Practice Address - Fax:704-597-3734
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-10
Last Update Date:2007-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2723235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist