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General NPI Number Information
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NPI Number | 1356605760
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Entity Type | Individual
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Provider Name | THERESA MARIE MAYHEW MA
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Gender | Female
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Dates
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Enumeration Date | 06/29/2012
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 1114 MAIN ST
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City | YOUNG HARRIS
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State | GA
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Zip | 30582-3058
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Country | US
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Telephone | 770-296-5175
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Fax | 706-710-2355
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Provider Business Mailing Address
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Address Line | PO BOX 62
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City | YOUNG HARRIS
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State | GA
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Zip | 30582-0062
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Country | US
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Telephone | 770-296-5175
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Fax | 706-710-2355
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC008594
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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