Provider Demographics
NPI:1730103458
Name:DEUTSCH, MAUREEN D (LPC)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:D
Last Name:DEUTSCH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6631 SANTA CRUZ TRL STE 218
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-8046
Mailing Address - Country:US
Mailing Address - Phone:704-414-0963
Mailing Address - Fax:
Practice Address - Street 1:6631 SANTA CRUZ TRL STE 218
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-8046
Practice Address - Country:US
Practice Address - Phone:704-414-0963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLMHC-7626101YM0800X
AZCADAC 2090101YA0400X
FLFCB 5489101YA0400X
FLMH7626101YM0800X
AZRLPC 15113101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ086MOtherBCBS PIN