Provider Demographics
NPI:1679867238
Name:MAYNARD, JOHN S (MA, LPA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:S
Last Name:MAYNARD
Suffix:
Gender:M
Credentials:MA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 WILSON DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-8781
Mailing Address - Country:US
Mailing Address - Phone:828-268-2172
Mailing Address - Fax:
Practice Address - Street 1:249 WILSON DR
Practice Address - Street 2:SUITE 5
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-8781
Practice Address - Country:US
Practice Address - Phone:828-268-2172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC195103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical