Provider Demographics
NPI:1609287408
Name:MOTZNY, MAHALA (MS/EDS)
Entity Type:Individual
Prefix:
First Name:MAHALA
Middle Name:
Last Name:MOTZNY
Suffix:
Gender:F
Credentials:MS/EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 ASHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3422
Mailing Address - Country:US
Mailing Address - Phone:336-408-6917
Mailing Address - Fax:
Practice Address - Street 1:2235 LEWISVILLE CLEMMONS RD STE A
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-9342
Practice Address - Country:US
Practice Address - Phone:336-408-6917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12183101YM0800X
NC2022101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)