Healthcare Provider Details

I. General information

NPI: 1861310757
Provider Name (Legal Business Name): CASEY MADELINE PAYNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 OCEAN HWY W
SUPPLY NC
28462-4048
US

IV. Provider business mailing address

PO BOX 281
BOLIVIA NC
28422-0281
US

V. Phone/Fax

Practice location:
  • Phone: 910-253-5885
  • Fax: 910-253-5887
Mailing address:
  • Phone: 910-253-5885
  • Fax: 910-253-5887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: