Provider Demographics
NPI:1689392110
Name:PRINCE, CODY LEE (MA, LMFTA)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:LEE
Last Name:PRINCE
Suffix:
Gender:M
Credentials:MA, LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 S COX ST
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5714
Mailing Address - Country:US
Mailing Address - Phone:336-860-3262
Mailing Address - Fax:336-521-7550
Practice Address - Street 1:379 S COX ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5714
Practice Address - Country:US
Practice Address - Phone:336-860-3262
Practice Address - Fax:336-521-7550
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12447A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist