Provider Demographics
NPI:1740216647
Name:HOLLIFIELD, CAROLYN NOELLE (MS CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:NOELLE
Last Name:HOLLIFIELD
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:PINE LEVEL
Mailing Address - State:NC
Mailing Address - Zip Code:27568-0208
Mailing Address - Country:US
Mailing Address - Phone:919-219-7614
Mailing Address - Fax:919-882-1489
Practice Address - Street 1:116 JAMES DR
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:NC
Practice Address - Zip Code:27576-9381
Practice Address - Country:US
Practice Address - Phone:919-219-7614
Practice Address - Fax:919-882-1489
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6671235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412437Medicaid