Provider Demographics
NPI:1659402170
Name:MABRY, DAVID (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:MABRY
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 EASTWOOD LN SE
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-8502
Mailing Address - Country:US
Mailing Address - Phone:910-620-4927
Mailing Address - Fax:
Practice Address - Street 1:801 N HOWE ST STE 8
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-3351
Practice Address - Country:US
Practice Address - Phone:910-620-4927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4776101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional