=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699893420
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARGUINIA LYNN NANCE M.A.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2007
-----------------------------------------------------
Last Update Date | 12/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1430 WILLOW LN # C61-2
-----------------------------------------------------
City | NORTH WILKESBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28659
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-667-5151
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 WILLOW LN
-----------------------------------------------------
City | NORTH WILKESBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28659-3551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-667-5151
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | S7138
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------