Provider Demographics
NPI:1801339304
Name:MAYES-MAHER, ELISA
Entity type:Individual
Prefix:MRS
First Name:ELISA
Middle Name:
Last Name:MAYES-MAHER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ELISA
Other - Middle Name:
Other - Last Name:MAYES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW-A
Mailing Address - Street 1:5900 CHASON RIDGE DR APT C
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-4400
Mailing Address - Country:US
Mailing Address - Phone:215-768-4824
Mailing Address - Fax:
Practice Address - Street 1:690 N REILLY RD STE 104
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5724
Practice Address - Country:US
Practice Address - Phone:910-879-6102
Practice Address - Fax:910-882-8348
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0108711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical