Provider Demographics
NPI:1538032792
Name:ENGEBRETSON, MARK (LCMHCA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:ENGEBRETSON
Suffix:
Gender:M
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 MARTINS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BARNARDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28709-8703
Mailing Address - Country:US
Mailing Address - Phone:629-333-5200
Mailing Address - Fax:
Practice Address - Street 1:171 MARTINS CREEK RD
Practice Address - Street 2:
Practice Address - City:BARNARDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28709-8703
Practice Address - Country:US
Practice Address - Phone:629-333-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA22070101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health