MEDICARE: IN SESSION THERAPEUTIC SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center
4	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1992493233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN SESSION THERAPEUTIC SERVICES

Provider Business Mailing Address
First Line	:	180 WARREN LAKE RD
Second Line	:
City	:	ABERDEEN
State	:	NC
Zip	:	28315-7058
Country	:	US
Telephone Number	:	910-973-6423
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 WARREN LAKE RD
Second Line	:
City	:	ABERDEEN
State	:	NC
Zip	:	28315-7058
Country	:	US
Telephone Number	:	910-973-6423
Fax Number	:

Authorized Official
Title or Position	:	SOCIAL WORKER
Name	:	MRS. SAMANTHA MARTHA MAYBERN
Credential	:	LCSW
Telephone Number	:	337-353-4056

Provider Enumeration Date	:	04/25/2023
Last Update Date	:	04/25/2023

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