Provider Demographics
NPI:1548769920
Name:MAYFIELD, MARYELLEN MCILWAIN (LICSW)
Entity Type:Individual
Prefix:
First Name:MARYELLEN
Middle Name:MCILWAIN
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:TUSCUMBIA
Mailing Address - State:AL
Mailing Address - Zip Code:35674-1601
Mailing Address - Country:US
Mailing Address - Phone:256-762-9125
Mailing Address - Fax:
Practice Address - Street 1:398 ASHE BLVD
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-1729
Practice Address - Country:US
Practice Address - Phone:256-383-1499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4109C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical