Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 2506 | NC |
Y | 103TC0700X | Clinical Psychologist | 2506 | NC |
NPI | 1003846239 |
---|---|
Provider Name | Dr. Mary Beth Barnes |
First Address | Willow Spring, NC 27592-6524 |
Second Address | Fayetteville, NC 28301-3856 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 19/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2506 | STATE LICENSE (01) | NC |