Provider Demographics
NPI:1548465800
Name:UTT, MARY BRISTOW (LPC, M OF ED)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BRISTOW
Last Name:UTT
Suffix:
Gender:F
Credentials:LPC, M OF ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 W WINDWARD LANDING PL
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-2476
Mailing Address - Country:US
Mailing Address - Phone:910-319-0090
Mailing Address - Fax:
Practice Address - Street 1:4000 OLEANDER DR
Practice Address - Street 2:SUITE 2-A
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6846
Practice Address - Country:US
Practice Address - Phone:910-392-5889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5247101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional