Provider Demographics
NPI:1114742319
Name:HENLEY, CAROLYN GRACE (LMT)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:GRACE
Last Name:HENLEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:GRACE
Other - Last Name:ORR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:5600 MOREHEAD RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-3927
Mailing Address - Country:US
Mailing Address - Phone:980-844-8555
Mailing Address - Fax:
Practice Address - Street 1:5600 MOREHEAD RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-3927
Practice Address - Country:US
Practice Address - Phone:980-844-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19538225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist