Provider Demographics
NPI:1700478815
Name:MAUST, ANNE HANSON (LCMHCA)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:HANSON
Last Name:MAUST
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 NAVAN LN
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-5045
Mailing Address - Country:US
Mailing Address - Phone:828-243-2379
Mailing Address - Fax:
Practice Address - Street 1:824 N BLOODWORTH ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1232
Practice Address - Country:US
Practice Address - Phone:919-780-4589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15951101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health