Healthcare Provider Details

I. General information

NPI: 1659948818
Provider Name (Legal Business Name): PAYTON MAKAYLA AUSTIN LCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 LONNIE CT
WINGATE NC
28174-4103
US

IV. Provider business mailing address

2004 LONNIE CT
WINGATE NC
28174-4103
US

V. Phone/Fax

Practice location:
  • Phone: 919-729-5584
  • Fax:
Mailing address:
  • Phone: 919-729-5584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA16596
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: