Provider Demographics
NPI:1720213887
Name:AROKIASAMY, MARIA WINSTON (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:MARIA
Middle Name:WINSTON
Last Name:AROKIASAMY
Suffix:
Gender:M
Credentials:CCC-SLP
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 1325
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28359-1325
Mailing Address - Country:US
Mailing Address - Phone:910-671-6769
Mailing Address - Fax:910-401-1004
Practice Address - Street 1:209 W. 14TH ST.
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358
Practice Address - Country:US
Practice Address - Phone:910-671-6769
Practice Address - Fax:910-401-1004
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2895235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1558552950Medicaid