Provider Demographics
NPI:1376328831
Name:MAHER, DAVID BRANDON
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BRANDON
Last Name:MAHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 MILL ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4975
Mailing Address - Country:US
Mailing Address - Phone:770-403-0825
Mailing Address - Fax:
Practice Address - Street 1:80 MILL ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4975
Practice Address - Country:US
Practice Address - Phone:770-403-0825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006562101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor