Provider Demographics
NPI:1790034593
Name:HUNT, MARA D (LCSW)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:D
Last Name:HUNT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 E WARDELL DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-7998
Mailing Address - Country:US
Mailing Address - Phone:910-521-2816
Mailing Address - Fax:910-521-3583
Practice Address - Street 1:60 COMMERCE PLAZA CIR
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-7386
Practice Address - Country:US
Practice Address - Phone:910-521-2900
Practice Address - Fax:910-775-9165
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-07
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0064611041C0700X
NCC0085751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
12614200OtherCAQH
NC1790034593OtherBCBSNC
NC1790034593Medicaid
NCQ44930AMedicare PIN