Provider Demographics
NPI:1699267930
Name:FURNER, EMMITT MAXWELL II (LPC)
Entity type:Individual
Prefix:MR
First Name:EMMITT
Middle Name:MAXWELL
Last Name:FURNER
Suffix:II
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 AIKEN RD
Mailing Address - Street 2:
Mailing Address - City:VASS
Mailing Address - State:NC
Mailing Address - Zip Code:28394-9299
Mailing Address - Country:US
Mailing Address - Phone:202-725-8826
Mailing Address - Fax:
Practice Address - Street 1:104 LAKE AVE
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-3937
Practice Address - Country:US
Practice Address - Phone:202-725-8826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-02
Last Update Date:2018-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13362101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional