MEDICARE: HEATHER MAYTON LPCA, MS

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	101YP2500X	Professional Counselor	A10996	NC

General Provider Information

NPI Number	:	1306246442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER MAYTON LPCA, MS

Provider Business Mailing Address
First Line	:	2400 LAKE BRANDT PL APT R
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27455-2044
Country	:	US
Telephone Number	:	336-212-1787
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 LAKE BRANDT PL APT R
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27455-2044
Country	:	US
Telephone Number	:	336-212-1787
Fax Number	:

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

Provider Enumeration Date	:	08/26/2014
Last Update Date	:	09/17/2014

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