MEDICARE: ANNE L MAULDIN, PH.D., PA

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	251S00000X	Community/Behavioral Health Agency	2854	NC

General Provider Information

NPI Number	:	1689820235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANNE L MAULDIN, PH.D., PA

Provider Business Mailing Address
First Line	:	704 CROMWELL DR
Second Line	:	STE B
City	:	GREENVILLE
State	:	NC
Zip	:	27858-5894
Country	:	US
Telephone Number	:	252-215-0046
Fax Number	:	252-215-0044

Provider Business Practice Location Address
First Line	:	704 CROMWELL DR STE B
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27858-5894
Country	:	US
Telephone Number	:	252-215-0046
Fax Number	:	252-215-0044

Authorized Official
Title or Position	:	PRESIDENT, LICENSED PSYCHOLOGIST
Name	:	DR. ANNE L MAULDIN
Credential	:	PH.D.
Telephone Number	:	252-215-0046

Provider Enumeration Date	:	08/14/2008
Last Update Date	:	08/14/2008

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