MEDICARE: ANNE HANSON MAUST LCMHCA

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	A15951	NC

General Provider Information

NPI Number	:	1700478815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE HANSON MAUST LCMHCA

Provider Business Mailing Address
First Line	:	2010 NAVAN LN
Second Line	:
City	:	GARNER
State	:	NC
Zip	:	27529-5045
Country	:	US
Telephone Number	:	828-243-2379
Fax Number	:

Provider Business Practice Location Address
First Line	:	824 N BLOODWORTH ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-1232
Country	:	US
Telephone Number	:	919-780-4589
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2021
Last Update Date	:	02/09/2021

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