Provider Demographics
NPI:1871356691
Name:MARIUS MAXIMUS FOUNDATION FOR MENTAL HEALTH INC.
Entity type:Organization
Organization Name:MARIUS MAXIMUS FOUNDATION FOR MENTAL HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ILANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:NCCPSS
Authorized Official - Phone:910-518-9192
Mailing Address - Street 1:5288 EASON RD
Mailing Address - Street 2:
Mailing Address - City:WADE
Mailing Address - State:NC
Mailing Address - Zip Code:28395-8990
Mailing Address - Country:US
Mailing Address - Phone:910-496-6854
Mailing Address - Fax:
Practice Address - Street 1:128 S KING ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5970
Practice Address - Country:US
Practice Address - Phone:910-518-9192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251V00000XAgenciesVoluntary or Charitable
No175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty