Provider Demographics
NPI:1760708986
Name:JAVEL, MARY E (PHD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:JAVEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 JUDGES RD STE 4E
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3655
Mailing Address - Country:US
Mailing Address - Phone:910-791-6767
Mailing Address - Fax:
Practice Address - Street 1:2 JOHNNY MERCER BLVD
Practice Address - Street 2:APT. 401
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-3329
Practice Address - Country:US
Practice Address - Phone:276-206-0158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1522103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical