Provider Demographics
NPI:1871832915
Name:A PLUS SPEECH THERAPY, PPLC
Entity Type:Organization
Organization Name:A PLUS SPEECH THERAPY, PPLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:NOELLE
Authorized Official - Last Name:HOLLIFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:919-219-5549
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:919-219-5549
Mailing Address - Fax:
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:919-219-5549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-09
Last Update Date:2013-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6671235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412437Medicaid