Provider Demographics
NPI:1003003039
Name:BARINE, MARY MUTHONI (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MUTHONI
Last Name:BARINE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 WINDEMERE LN
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-9562
Mailing Address - Country:US
Mailing Address - Phone:919-562-7713
Mailing Address - Fax:
Practice Address - Street 1:916 WINDEMERE LN
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-9562
Practice Address - Country:US
Practice Address - Phone:919-562-7713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6689101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103715Medicaid