Provider Demographics
NPI:1891324976
Name:PARRISH, ELYSE (LMBT, RYT)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:
Last Name:PARRISH
Suffix:
Gender:F
Credentials:LMBT, RYT
Other - Prefix:
Other - First Name:ELYSE
Other - Middle Name:
Other - Last Name:ROLFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMBT, RYT
Mailing Address - Street 1:143 SKATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-2640
Mailing Address - Country:US
Mailing Address - Phone:910-864-6257
Mailing Address - Fax:
Practice Address - Street 1:143 SKATEWAY DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2640
Practice Address - Country:US
Practice Address - Phone:910-864-6257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NC17583225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1275172298Medicaid