Provider Demographics
NPI:1881277937
Name:SHINNICK, MAYA CHRISTINE
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:CHRISTINE
Last Name:SHINNICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 FRONT AVE UNIT 238
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-6407
Mailing Address - Country:US
Mailing Address - Phone:732-272-2858
Mailing Address - Fax:
Practice Address - Street 1:1329 FRONT AVE UNIT 238
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-6407
Practice Address - Country:US
Practice Address - Phone:732-272-2858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00759600101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor