Provider Demographics
NPI:1679694830
Name:DURHAM, CARLA SANFORD (MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:SANFORD
Last Name:DURHAM
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 SHERMAN ST SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-3150
Mailing Address - Country:US
Mailing Address - Phone:256-301-9979
Mailing Address - Fax:256-301-9979
Practice Address - Street 1:1036 SHERMAN ST SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3150
Practice Address - Country:US
Practice Address - Phone:256-301-9979
Practice Address - Fax:256-301-9979
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist