MEDICARE: DOCTOR MAYS-COUCH LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1477296457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOCTOR MAYS-COUCH LLC

Provider Business Mailing Address
First Line	:	PO BOX 32
Second Line	:
City	:	FARMVILLE
State	:	VA
Zip	:	23901-0032
Country	:	US
Telephone Number	:	434-542-3315
Fax Number	:

Provider Business Practice Location Address
First Line	:	1839 THOMAS JEFFERESON HWY
Second Line	:
City	:	CHARLOTTE COURTHOUSE
State	:	VA
Zip	:	23923
Country	:	US
Telephone Number	:	434-542-3315
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SHELLEY MAYS-COUCH
Credential	:	LCSW
Telephone Number	:	434-315-1817

Provider Enumeration Date	:	04/18/2022
Last Update Date	:	04/18/2022

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Directions to “DOCTOR MAYS-COUCH LLC ” Practice Location

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