Provider Demographics
NPI:1841354768
Name:MAUL, DESMOND ORVILLE (LMFT)
Entity type:Individual
Prefix:DR
First Name:DESMOND
Middle Name:ORVILLE
Last Name:MAUL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 EXCHANGE PL SE STE A
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-6723
Mailing Address - Country:US
Mailing Address - Phone:770-679-0586
Mailing Address - Fax:770-285-6325
Practice Address - Street 1:2012 EASTVIEW PKWY STE 400
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-5701
Practice Address - Country:US
Practice Address - Phone:770-679-0586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMFT000266101YM0800X, 106H00000X
GA01191101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPERSONAL CHOICEOtherPSYCHOLOGICAL SERVICES
PAAETNAOtherPSYCHOLOGICAL SERVICES
NJHORIZONBLUE CROSSOtherPSYCHOLOGICAL SERVICES
NJBLUECROSSBLUESHIELDOtherPSYCHOLOGICAL SERVICES
PAHIGHMARKOtherPSYCHOLOGICAL SERVICES
PABLUE CROSS BLUE SHIEOtherPSYCHOLOGICAL SERRVICES
DEBLUECROSSBLUE SHIELDOtherPSYCHOLOGICAL SERVICES
UNITED HEALTHCAREOtherPSYCHOLOGICAL SERVICES