Healthcare Provider Details

I. General information

NPI: 1669396818
Provider Name (Legal Business Name): MAE WELLNESS CO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 SE MAYNARD RD STE 203
CARY NC
27511-6944
US

IV. Provider business mailing address

PO BOX 80192
RALEIGH NC
27623-0192
US

V. Phone/Fax

Practice location:
  • Phone: 910-644-0878
  • Fax: 919-251-8515
Mailing address:
  • Phone: 910-644-0878
  • Fax: 919-251-8515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ASHAUNTIS TANAE MCNAIR
Title or Position: OWNER
Credential: LCSW
Phone: 910-476-9427