MEDICARE: MS. DEEPA BHATT-MACKIN MA LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	4883	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235211855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEEPA BHATT-MACKIN MA LPC

Provider Business Mailing Address
First Line	:	615 EDENBERRY DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-6535
Country	:	US
Telephone Number	:	919-765-0062
Fax Number	:

Provider Business Practice Location Address
First Line	:	3725 NATIONAL DR STE 114
Second Line	:	NORTH HAMPTON BUILDING
City	:	RALEIGH
State	:	NC
Zip	:	27612-4879
Country	:	US
Telephone Number	:	919-784-0508
Fax Number	:	919-784-0250

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	07/08/2007

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