Healthcare Provider Details

I. General information

NPI: 1760572549
Provider Name (Legal Business Name): NANCY C MAYO MS, MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 MALLOY ST UNIT E
GOLDSBORO NC
27534
US

IV. Provider business mailing address

306 CEDAR RD
GOLDSBORO NC
27534-3204
US

V. Phone/Fax

Practice location:
  • Phone: 919-778-5594
  • Fax: 919-778-5633
Mailing address:
  • Phone: 919-778-9552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number674
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: