Provider Demographics
NPI:1720482904
Name:TRAVOLINA, DENISE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:TRAVOLINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 STONE MASON CT APT M
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-5583
Mailing Address - Country:US
Mailing Address - Phone:708-595-3048
Mailing Address - Fax:
Practice Address - Street 1:1541 LAUREL OAK DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-6221
Practice Address - Country:US
Practice Address - Phone:708-595-3048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-16
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician