Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | 1886 | NC |
NPI | 1699870295 |
---|---|
Provider Name | Mary Elizabeth Tota-Faucette |
First Address | Winston-Salem, NC 27103 |
Second Address | Charlotte, NC 28204-3227 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 28/10/2020 |