Provider Demographics
NPI:1942443643
Name:MAYNARD, LAURIE R (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:R
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 N PARK AVE
Mailing Address - Street 2:801 NORTH
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-7239
Mailing Address - Country:US
Mailing Address - Phone:301-564-8004
Mailing Address - Fax:
Practice Address - Street 1:4500 N PARK AVE
Practice Address - Street 2:801 NORTH
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-7239
Practice Address - Country:US
Practice Address - Phone:301-564-8004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3034101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional