Provider Demographics
NPI:1114125929
Name:MAYNOR, LOUISE DAVIS (PSYD)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:DAVIS
Last Name:MAYNOR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 55TH ST
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2609
Mailing Address - Country:US
Mailing Address - Phone:510-655-7880
Mailing Address - Fax:510-655-3379
Practice Address - Street 1:13815 PROFESSIONAL CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7951
Practice Address - Country:US
Practice Address - Phone:704-384-1320
Practice Address - Fax:704-316-3138
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24719101YM0800X
NC4723103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health