Provider Demographics
NPI:1962660142
Name:CONNOLLY, CAROLINE MISENHEIMER (LMBT, NCMBT)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:MISENHEIMER
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:LMBT, NCMBT
Other - Prefix:MISS
Other - First Name:CAROLINE
Other - Middle Name:NOVIE
Other - Last Name:MISENHEIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMT
Mailing Address - Street 1:4420 OAKSONG DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-0512
Mailing Address - Country:US
Mailing Address - Phone:252-414-3552
Mailing Address - Fax:
Practice Address - Street 1:605 LYNNDALE CT
Practice Address - Street 2:SUITE D
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5449
Practice Address - Country:US
Practice Address - Phone:252-414-3552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-24
Last Update Date:2008-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7021225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist