Provider Demographics
NPI:1538904834
Name:THOMAS FORNEY, CAROLYN (LMBT)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:THOMAS FORNEY
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 NAVIGATOR CT
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6910
Mailing Address - Country:US
Mailing Address - Phone:704-977-3150
Mailing Address - Fax:
Practice Address - Street 1:224 ROLLING HILL RD STE 1B
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6511
Practice Address - Country:US
Practice Address - Phone:704-977-3150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09912225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist