Provider Demographics
NPI:1710015813
Name:MAULDIN, ANNE LUTHER (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:LUTHER
Last Name:MAULDIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 CROMWELL DR STE B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5894
Mailing Address - Country:US
Mailing Address - Phone:252-215-0046
Mailing Address - Fax:252-215-0044
Practice Address - Street 1:704 CROMWELL DR STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5894
Practice Address - Country:US
Practice Address - Phone:252-215-0046
Practice Address - Fax:252-215-0044
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2854103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC045XFOtherBLUE CROSS BLUE SHIELD
NC6000375Medicaid