Provider Demographics
NPI:1447902580
Name:MAYHEW, DEBORAH FULLER (LCSWA)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:FULLER
Last Name:MAYHEW
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:FULLER
Other - Last Name:MAYHEW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSWA
Mailing Address - Street 1:11925 OVERLOOK MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-7775
Mailing Address - Country:US
Mailing Address - Phone:704-605-7547
Mailing Address - Fax:
Practice Address - Street 1:4822 ALBEMARLE RD STE 219
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6656
Practice Address - Country:US
Practice Address - Phone:704-405-4265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP015818104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty