Provider Demographics
NPI:1699851956
Name:TUMLIN-CARROLL, LILLIAN (SPEECH THERAPIST)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:TUMLIN-CARROLL
Suffix:
Gender:F
Credentials:SPEECH THERAPIST
Other - Prefix:
Other - First Name:MARCI
Other - Middle Name:
Other - Last Name:TUMLIN-CARROLL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED,CCC-SLP
Mailing Address - Street 1:1822-6 S GLENBURNIE RD
Mailing Address - Street 2:SUITE 377
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5221
Mailing Address - Country:US
Mailing Address - Phone:252-675-3621
Mailing Address - Fax:
Practice Address - Street 1:1916 S GLENBURNIE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5266
Practice Address - Country:US
Practice Address - Phone:252-675-3621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-30
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5220235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411644Medicaid
NC127C2OtherBC