Active NPI
Elizabeth McCann Mines, CTRS,MS
- Recreation Therapist
- Fayetteville, NC
National Provider Identifier
1699854232
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreation Therapist
- License
- 1510
- Practice address
- 4810 Ramsey St
Fayetteville, NC 28311-1602 - Phone
- (910) 488-8887
- NPI assigned
- Nov 3, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | 1510 | NC | Primary |
Addresses
Primary practice location
4810 Ramsey St
Fayetteville, NC 28311-1602
Mailing address
4810 Ramsey St
Fayetteville, NC 28311-1602
Phone (910) 488-8887
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1510 | Other | VA | LICENSE FOR THERAPY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1510 | NC | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1699854232",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4810 RAMSEY ST",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283111602",
"telephone_number": "910-488-8887"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4810 RAMSEY ST",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283111602",
"telephone_number": "910-488-8887"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MINES",
"first_name": "ELIZABETH",
"middle_name": "MCCANN",
"name_prefix": "Mrs.",
"credential": "CTRS,MS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": "NC",
"license": "1510",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE FOR THERAPY",
"identifier": "1510",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.