Provider Demographics
NPI:1841414257
Name:STATE OF NC DIVISION OF HEALTH SERVICES
Entity Type:Organization
Organization Name:STATE OF NC DIVISION OF HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EARLY INTERVENTION BRANCH HEAD
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARROLLD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-707-5520
Mailing Address - Street 1:DPH- EARLY INTERVENTION BR
Mailing Address - Street 2:1916 MAIL SERVICE CENTER
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27699-1916
Mailing Address - Country:US
Mailing Address - Phone:919-707-5520
Mailing Address - Fax:919-870-4834
Practice Address - Street 1:1211A IRELAND DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3372
Practice Address - Country:US
Practice Address - Phone:919-486-1605
Practice Address - Fax:919-486-1590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3403412Medicaid
NC13409OtherBLUE CROSS BLUE SHIELD