Healthcare Provider Details

I. General information

NPI: 1821767476
Provider Name (Legal Business Name): MAUREEN GUPTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 PROVIDENCE RD
CHAPEL HILL NC
27514-2206
US

IV. Provider business mailing address

107 HILL ST
SMITHFIELD NC
27577-3303
US

V. Phone/Fax

Practice location:
  • Phone: 919-695-9445
  • Fax:
Mailing address:
  • Phone: 919-333-7375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP016764
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: