Healthcare Provider Details

I. General information

NPI: 1548070584
Provider Name (Legal Business Name): ANTHONY MCLAURIN MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2025
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5845 YADKIN RD STE D
FAYETTEVILLE NC
28303-2656
US

IV. Provider business mailing address

5845 YADKIN RD STE D
FAYETTEVILLE NC
28303-2656
US

V. Phone/Fax

Practice location:
  • Phone: 910-849-0794
  • Fax:
Mailing address:
  • Phone: 910-849-0794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA20965
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: