Provider Demographics
NPI:1306246442
Name:MAYTON, HEATHER (LPCA, MS)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MAYTON
Suffix:
Gender:F
Credentials:LPCA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 LAKE BRANDT PL APT R
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2044
Mailing Address - Country:US
Mailing Address - Phone:336-212-1787
Mailing Address - Fax:
Practice Address - Street 1:2400 LAKE BRANDT PL APT R
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2044
Practice Address - Country:US
Practice Address - Phone:336-212-1787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10996101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional