Basic Information
| Provider Information | |||||||||
| NPI: | 1114073004 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAYHEW | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | DOUGLAS | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MS, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 505 RUBY ST | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277044139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196068098 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2304 S MIAMI BLVD | ||||||||
| Address2: | SUITE 221 | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277034916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198060509 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2007 | ||||||||
| LastUpdateDate: | 01/12/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 7716 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.