Provider Demographics
NPI:1740528777
Name:MAGGIE GAINEY, PHD, LLC
Entity type:Organization
Organization Name:MAGGIE GAINEY, PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:GAINEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:864-356-0299
Mailing Address - Street 1:324 E SAINT JOHN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-1505
Mailing Address - Country:US
Mailing Address - Phone:864-356-0299
Mailing Address - Fax:
Practice Address - Street 1:324 E SAINT JOHN ST
Practice Address - Street 2:SUITE B
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1505
Practice Address - Country:US
Practice Address - Phone:864-356-0299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC885103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1169408OtherCAQH PROVIDER #
1169408OtherCAQH PROVIDER #