Healthcare Provider Details

I. General information

NPI: 1194592931
Provider Name (Legal Business Name): WILLIAM JUSTIN MAYNARD LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3730 WASHINGTON RD STE 200
AUGUSTA GA
30907-4196
US

IV. Provider business mailing address

3730 WASHINGTON RD STE 200
AUGUSTA GA
30907-4196
US

V. Phone/Fax

Practice location:
  • Phone: 706-471-0603
  • Fax: 706-480-6617
Mailing address:
  • Phone: 706-471-0603
  • Fax: 706-480-6617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC017063
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: