Provider Demographics
NPI:1467915306
Name:DEVLIN, MARY ELIZABETH
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:DEVLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:DEESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2520 HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-4032
Mailing Address - Country:US
Mailing Address - Phone:704-490-8585
Mailing Address - Fax:
Practice Address - Street 1:900 BRANCHVIEW DR NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2213
Practice Address - Country:US
Practice Address - Phone:704-780-4271
Practice Address - Fax:704-788-2016
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician