Provider Demographics
NPI:1083750715
Name:MAYBECK, DAWN ADELAIDE (MA)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:ADELAIDE
Last Name:MAYBECK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 S TRYON ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4459
Mailing Address - Country:US
Mailing Address - Phone:704-342-8390
Mailing Address - Fax:704-342-8391
Practice Address - Street 1:1714 S TRYON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4459
Practice Address - Country:US
Practice Address - Phone:704-342-8390
Practice Address - Fax:704-342-8391
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2078101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional