Provider Demographics
NPI:1639476567
Name:CHRISTIAN-MCKEEVER, MAYA
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:CHRISTIAN-MCKEEVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4422 E COLUMBUS DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33605-3233
Mailing Address - Country:US
Mailing Address - Phone:813-984-1818
Mailing Address - Fax:813-630-0082
Practice Address - Street 1:1463 OAKFIELD DR STE 113
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-0815
Practice Address - Country:US
Practice Address - Phone:813-413-1065
Practice Address - Fax:813-571-9697
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP4281101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)