MEDICARE: MARIE AGIUS LPC, LCAS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	1670	NC
2	101YP2500X	Professional Counselor	10379	NC

General Provider Information

NPI Number	:	1275989311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE AGIUS LPC, LCAS

Provider Business Mailing Address
First Line	:	7000 HARPS MILL RD
Second Line	:	SUITE 102
City	:	RALEIGH
State	:	NC
Zip	:	27615-3239
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7000 HARPS MILL RD
Second Line	:	SUITE 102
City	:	RALEIGH
State	:	NC
Zip	:	27615-3239
Country	:	US
Telephone Number	:	919-886-4052
Fax Number	:

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

Provider Enumeration Date	:	05/08/2016
Last Update Date	:	05/08/2016

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