Provider Demographics
NPI:1154823227
Name:DELK, MAEKELA (LCMHCA)
Entity Type:Individual
Prefix:MS
First Name:MAEKELA
Middle Name:
Last Name:DELK
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 ROCK RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-1989
Mailing Address - Country:US
Mailing Address - Phone:615-830-4391
Mailing Address - Fax:
Practice Address - Street 1:10307 TISBURY RD APT 8103
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-2490
Practice Address - Country:US
Practice Address - Phone:615-830-4391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13587101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional