Healthcare Provider Details

I. General information

NPI: 1447141346
Provider Name (Legal Business Name): MAXIMILIAN HVASTA LCMHC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

655 SPORTSMAN DR
SALISBURY NC
28146-2580
US

IV. Provider business mailing address

655 SPORTSMAN DR
SALISBURY NC
28146-2580
US

V. Phone/Fax

Practice location:
  • Phone: 980-621-6772
  • Fax:
Mailing address:
  • Phone: 980-621-6772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA21709
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA21709
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: