Provider Demographics
NPI:1871648824
Name:MACON, ADRIENNE HENDERSON (LCMHCS)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:HENDERSON
Last Name:MACON
Suffix:
Gender:F
Credentials:LCMHCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3439
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27204-3439
Mailing Address - Country:US
Mailing Address - Phone:336-963-4391
Mailing Address - Fax:
Practice Address - Street 1:180 B BROWERS CHAPEL RD
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27205
Practice Address - Country:US
Practice Address - Phone:336-963-4391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2024-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5552101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health