Provider Demographics
NPI:1922149830
Name:BURNS-SPELLER, CAROLYN DENISE (MS)
Entity Type:Individual
Prefix:MISS
First Name:CAROLYN
Middle Name:DENISE
Last Name:BURNS-SPELLER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 HAMPSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28146-7211
Mailing Address - Country:US
Mailing Address - Phone:336-723-5861
Mailing Address - Fax:336-723-6746
Practice Address - Street 1:1720 HAMPSHIRE DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28146-7211
Practice Address - Country:US
Practice Address - Phone:336-723-5861
Practice Address - Fax:336-723-6746
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2045101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102483Medicaid