Healthcare Provider Details

I. General information

NPI: 1679464564
Provider Name (Legal Business Name): MASON ANDREW POYTHRESS LCMHCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7850 BRIER CREEK PKWY STE 220
RALEIGH NC
27617-8900
US

IV. Provider business mailing address

4705 UNIVERSITY DR BLDG 700
DURHAM NC
27707-3489
US

V. Phone/Fax

Practice location:
  • Phone: 919-578-7008
  • Fax:
Mailing address:
  • Phone: 919-237-1337
  • Fax: 866-538-4716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA21661
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: