Provider Demographics
NPI:1457436545
Name:MCNEILLY, MAYA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MAYA
Middle Name:
Last Name:MCNEILLY
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:PO BOX 822
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-0822
Mailing Address - Country:US
Mailing Address - Phone:919-567-9920
Mailing Address - Fax:919-567-9920
Practice Address - Street 1:1140 HOLLY SPRINGS RD
Practice Address - Street 2:SUITE 207
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-9634
Practice Address - Country:US
Practice Address - Phone:919-557-6111
Practice Address - Fax:919-567-9920
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1658103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0368MOtherBCBS
NC0368MOtherBCBS