Maxine Tibbetts, LCMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

15327 Issued in NC

Practice address

749 Lasater Rd
Bunnlevel, NC 28323-9137

Phone

(910) 257-8778

NPI assigned

May 27, 2015

Last updated

Oct 3, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dunndeal Counseling Services PLLC

  • Community/Behavioral Health Agency
  • Bunnlevel, NC
  • NPI 1255055125
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1432684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664755200000",
    "number": "1073992772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "749 LASATER RD",
            "city": "BUNNLEVEL",
            "state": "NC",
            "postal_code": "283239137",
            "telephone_number": "910-257-8778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "749 LASATER RD",
            "city": "BUNNLEVEL",
            "state": "NC",
            "postal_code": "283239137",
            "telephone_number": "910-257-8778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIBBETTS",
        "first_name": "MAXINE",
        "credential": "LCMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-05-27",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "15327",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073992772",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelsey Mendez, PA-C
• Lexie Michelle Receniello, MS, CCC-SLP
• Joshua Daniel Rentz, RN
• Chelsea Lynn Simpson, CBS
• Darla Renee Stephens-McCryndle
• Jamie White

• Mental Health Counselor in Bunnlevel, NC
• Providers in Bunnlevel, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.