Provider Demographics
NPI:1457544769
Name:CAROLINA LACTATION
Entity Type:Organization
Organization Name:CAROLINA LACTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LACTATION CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:TROMBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, IBCLC
Authorized Official - Phone:252-626-3165
Mailing Address - Street 1:203 RANDOMWOOD LN
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-9551
Mailing Address - Country:US
Mailing Address - Phone:252-626-3165
Mailing Address - Fax:
Practice Address - Street 1:203 RANDOMWOOD LN
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-9551
Practice Address - Country:US
Practice Address - Phone:252-626-3165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102-18812251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management