Provider Demographics
NPI:1285047696
Name:BOOTH, CAROLINE
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:
Last Name:BOOTH
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 1:1601 E MARKET ST
Mailing Address - Street 2:349 PROCTOR HALL
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27411-0002
Mailing Address - Country:US
Mailing Address - Phone:336-996-6265
Mailing Address - Fax:
Practice Address - Street 1:1601 E MARKET ST
Practice Address - Street 2:349 PROCTOR HALL
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27411-0002
Practice Address - Country:US
Practice Address - Phone:336-334-7916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4259101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health