Provider Demographics
NPI:1114281367
Name:MIRACLE, MARY SPAHN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:SPAHN
Last Name:MIRACLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:SPAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1901 N HARRISON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-2410
Mailing Address - Country:US
Mailing Address - Phone:919-677-0101
Mailing Address - Fax:919-677-0113
Practice Address - Street 1:1901 N HARRISON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-2410
Practice Address - Country:US
Practice Address - Phone:919-677-0101
Practice Address - Fax:919-677-0113
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9181101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional