Healthcare Provider Details

I. General information

NPI: 1174433205
Provider Name (Legal Business Name): MAZZYLYN HAMBY LCAS-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MEDICAL CENTER DR
WILMINGTON NC
28401-7353
US

IV. Provider business mailing address

1208 2ND ST SE
CONOVER NC
28613-1842
US

V. Phone/Fax

Practice location:
  • Phone: 910-970-4673
  • Fax:
Mailing address:
  • Phone: 828-469-8862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number32101
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: