Provider Demographics
NPI:1306836960
Name:DURHAM, MARK NOEL (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:NOEL
Last Name:DURHAM
Suffix:
Gender:M
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 CISCO RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-1338
Mailing Address - Country:US
Mailing Address - Phone:828-712-0366
Mailing Address - Fax:828-251-1028
Practice Address - Street 1:15 LARCHMONT RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-2412
Practice Address - Country:US
Practice Address - Phone:828-251-1027
Practice Address - Fax:828-251-1028
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4179101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1326ROtherBLUE CROSS BLUE SHIELD NC