Provider Demographics
NPI:1952932006
Name:MAAS, JUSTINE (LCAS, CSI)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:MAAS
Suffix:
Gender:F
Credentials:LCAS, CSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 LAKEMONT DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-3070
Mailing Address - Country:US
Mailing Address - Phone:443-624-7565
Mailing Address - Fax:
Practice Address - Street 1:211 E SIX FORKS RD STE 117
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7753
Practice Address - Country:US
Practice Address - Phone:919-833-8894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-25799101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)