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General NPI Number Information
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NPI Number | 1205781457
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Entity Type | Organization
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Legal Business Name | MARIUS MAXIMUS FOUNDATION FOR MENTAL HEALTH INC.
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Dates
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Enumeration Date | 03/03/2026
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Last Update Date | 03/03/2026
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Provider Practice Location Address
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Address Line | 205 W RUSSELL ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-5655
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Country | US
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Telephone | 910-518-9192
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Fax |
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Provider Business Mailing Address
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Address Line | 5288 EASON RD
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City | WADE
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State | NC
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Zip | 28395-8990
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Country | US
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Telephone | 910-496-6854
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ILANA SHEPPARD
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Credential | NCCPSS
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Telephone | 910-496-6854
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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