Provider Demographics
NPI:1801379318
Name:PAUGH, NATITIA (LAC, LMBT)
Entity Type:Individual
Prefix:
First Name:NATITIA
Middle Name:
Last Name:PAUGH
Suffix:
Gender:F
Credentials:LAC, LMBT
Other - Prefix:
Other - First Name:TISHA
Other - Middle Name:
Other - Last Name:PAUGH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC, LMBT
Mailing Address - Street 1:6305 DRYE HILL RD
Mailing Address - Street 2:
Mailing Address - City:STANFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:28163-5500
Mailing Address - Country:US
Mailing Address - Phone:704-309-4000
Mailing Address - Fax:
Practice Address - Street 1:1140 SAM NEWELL RD STE B1
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5065
Practice Address - Country:US
Practice Address - Phone:704-309-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC03388225700000X
NC1011171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist