MEDICARE: MARIUS MAXIMUS FOUNDATION FOR MENTAL HEALTH INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1205781457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIUS MAXIMUS FOUNDATION FOR MENTAL HEALTH INC.

Provider Business Mailing Address
First Line	:	5288 EASON RD
Second Line	:
City	:	WADE
State	:	NC
Zip	:	28395-8990
Country	:	US
Telephone Number	:	910-496-6854
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 W RUSSELL ST
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28301-5655
Country	:	US
Telephone Number	:	910-518-9192
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ILANA SHEPPARD
Credential	:	NCCPSS
Telephone Number	:	910-496-6854

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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