Provider Demographics
NPI:1982010237
Name:COMMON, CAROLYN (LMBT NC 3007)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:COMMON
Suffix:
Gender:F
Credentials:LMBT NC 3007
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 HENDERSONVILLE RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-3197
Mailing Address - Country:US
Mailing Address - Phone:828-774-5150
Mailing Address - Fax:
Practice Address - Street 1:1636 HENDERSONVILLE RD
Practice Address - Street 2:SUITE 115
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-3197
Practice Address - Country:US
Practice Address - Phone:828-774-5150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3007225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist