Provider Demographics
NPI:1285203182
Name:MCCOY, MAIA C (MSW, LSWAIC)
Entity Type:Individual
Prefix:
First Name:MAIA
Middle Name:C
Last Name:MCCOY
Suffix:
Gender:F
Credentials:MSW, LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 14TH AVE APT B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-6615
Mailing Address - Country:US
Mailing Address - Phone:206-981-6798
Mailing Address - Fax:
Practice Address - Street 1:101 ELLIOTT AVE W STE 500
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-4292
Practice Address - Country:US
Practice Address - Phone:509-906-3606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC61136090104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker