Provider Demographics
NPI:1932766227
Name:MCGUIRE, MARTHA VIRGINIA (LPCA)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:VIRGINIA
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12143 SAINT MARTIN RD
Mailing Address - Street 2:
Mailing Address - City:OAKBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28129-9796
Mailing Address - Country:US
Mailing Address - Phone:704-485-2072
Mailing Address - Fax:
Practice Address - Street 1:243 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3939
Practice Address - Country:US
Practice Address - Phone:704-983-7785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14608101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty