Provider Demographics
NPI:1659892180
Name:SEAGRAVES, MAGGIE W (MSW)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:W
Last Name:SEAGRAVES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:NEIL
Other - Last Name:WALTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:213 ADMIRAL CIR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-3527
Mailing Address - Country:US
Mailing Address - Phone:931-231-9722
Mailing Address - Fax:
Practice Address - Street 1:1090 OLD FLORENCE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-8401
Practice Address - Country:US
Practice Address - Phone:931-762-6505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-06
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health