Healthcare Provider Details

I. General information

NPI: 1639147762
Provider Name (Legal Business Name): MARILYN LAXTON LCMHC
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 GREENWAY RD STE 309A
BOONE NC
28607-3120
US

IV. Provider business mailing address

423 FAWN DR
BOONE NC
28607-8462
US

V. Phone/Fax

Practice location:
  • Phone: 828-265-4878
  • Fax:
Mailing address:
  • Phone: 828-265-4878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5032
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: