Provider Demographics
NPI:1255451431
Name:NORMAN, JUDITH MARY (MS, LPC)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:MARY
Last Name:NORMAN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3491 S EVANS ST STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-4534
Mailing Address - Country:US
Mailing Address - Phone:252-227-1577
Mailing Address - Fax:252-321-7840
Practice Address - Street 1:3491 S EVANS ST STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4534
Practice Address - Country:US
Practice Address - Phone:252-227-1577
Practice Address - Fax:252-321-7840
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5380101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103677Medicaid