Healthcare Provider Details

I. General information

NPI: 1790698298
Provider Name (Legal Business Name): MAUREEN ROHDE MARTIN LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 HENDERSONVILLE RD
ARDEN NC
28704-9742
US

IV. Provider business mailing address

821 CATHAY RD
WILMINGTON NC
28412-2963
US

V. Phone/Fax

Practice location:
  • Phone: 828-329-6949
  • Fax:
Mailing address:
  • Phone: 910-777-4619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-30886
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: