Provider Demographics
NPI:1932343605
Name:STAUNTON, MARY BARBARA (LPA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BARBARA
Last Name:STAUNTON
Suffix:
Gender:F
Credentials:LPA
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 175
Mailing Address - Street 2:
Mailing Address - City:ROCKWELL
Mailing Address - State:NC
Mailing Address - Zip Code:28138-0175
Mailing Address - Country:US
Mailing Address - Phone:704-279-0474
Mailing Address - Fax:
Practice Address - Street 1:425 7TH AVE SW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-3237
Practice Address - Country:US
Practice Address - Phone:828-327-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1771103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist