Provider Demographics
NPI:1740774736
Name:EWING, PAUL MAURICE
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:MAURICE
Last Name:EWING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 NANNYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-9003
Mailing Address - Country:US
Mailing Address - Phone:336-772-5711
Mailing Address - Fax:
Practice Address - Street 1:10643 KETTERING DR
Practice Address - Street 2:STE 109
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226
Practice Address - Country:US
Practice Address - Phone:704-762-1361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13979101YM0800X, 101YP2500X
NC13979101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional