Provider Demographics
NPI:1780731091
Name:THOMAS, BETTIE MCLAWHORN (MACCCSLP)
Entity type:Individual
Prefix:
First Name:BETTIE
Middle Name:MCLAWHORN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 W BRUSHY FORK RD
Mailing Address - Street 2:
Mailing Address - City:ZIONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28698-9235
Mailing Address - Country:US
Mailing Address - Phone:336-385-6302
Mailing Address - Fax:336-385-6302
Practice Address - Street 1:2901 W BRUSHY FORK RD
Practice Address - Street 2:
Practice Address - City:ZIONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28698-9235
Practice Address - Country:US
Practice Address - Phone:336-385-6302
Practice Address - Fax:336-385-6302
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1677235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7482785Medicaid