Provider Demographics
NPI:1699854232
Name:MINES, ELIZABETH MCCANN (CTRS,MS)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MCCANN
Last Name:MINES
Suffix:
Gender:F
Credentials:CTRS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4810 RAMSEY ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-1602
Mailing Address - Country:US
Mailing Address - Phone:910-488-8887
Mailing Address - Fax:
Practice Address - Street 1:4810 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-1602
Practice Address - Country:US
Practice Address - Phone:910-488-8887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1510225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1510OtherLICENSE FOR THERAPY