Healthcare Provider Details

I. General information

NPI: 1194525311
Provider Name (Legal Business Name): HEATHER PAXTON LCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 HENDERSON DR
JACKSONVILLE NC
28540-5601
US

IV. Provider business mailing address

1014 HENDRICKS AVE
JACKSONVILLE NC
28540-6816
US

V. Phone/Fax

Practice location:
  • Phone: 910-939-4663
  • Fax:
Mailing address:
  • Phone: 910-388-8737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: