MEDICARE: MARIGOLD BEHAVIORAL HEALTH, PLLC.

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1356189104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIGOLD BEHAVIORAL HEALTH, PLLC.

Provider Business Mailing Address
First Line	:	18 COURT SQ
Second Line	:
City	:	LEXINGTON
State	:	NC
Zip	:	27292-3351
Country	:	US
Telephone Number	:	336-247-2871
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 COURT SQ
Second Line	:
City	:	LEXINGTON
State	:	NC
Zip	:	27292-3351
Country	:	US
Telephone Number	:	336-247-2871
Fax Number	:

Authorized Official
Title or Position	:	OWNER, CLINICAL COUNSELOR
Name	:	SAMANTHA PERRY
Credential	:	MHS,LCMHCA, NCC, CTP
Telephone Number	:	336-247-2871

Provider Enumeration Date	:	07/16/2024
Last Update Date	:	07/16/2024

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