MEDICARE: DR. ANNE LUTHER MAULDIN PH.D.

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	103TC1900X	Counseling Psychologist	2854	NC
2	103TC0700X	Clinical Psychologist	2854	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	045XF	OTHER	NC	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710015813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNE LUTHER MAULDIN PH.D.

Provider Business Mailing Address
First Line	:	704 CROMWELL DR STE B
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27858-5894
Country	:	US
Telephone Number	:	252-215-0046
Fax Number	:	252-215-0044

Provider Business Practice Location Address
First Line	:	704 CROMWELL DR STE B
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27858-5894
Country	:	US
Telephone Number	:	252-215-0046
Fax Number	:	252-215-0044

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	05/31/2024

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