Provider Demographics
NPI:1235315441
Name:MAYA MCNEILLY PA, PH.D.
Entity Type:Organization
Organization Name:MAYA MCNEILLY PA, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-567-9920
Mailing Address - Street 1:PO BOX 822
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-0822
Mailing Address - Country:US
Mailing Address - Phone:919-567-9920
Mailing Address - Fax:919-567-9920
Practice Address - Street 1:1140 HOLLY SPRINGS RD
Practice Address - Street 2:SUITE #207
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540
Practice Address - Country:US
Practice Address - Phone:919-557-6111
Practice Address - Fax:919-567-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1658103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2335887Medicare PIN