Healthcare Provider Details

I. General information

NPI: 1649964180
Provider Name (Legal Business Name): MARIAH MEADE MACON MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 04/26/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

542 SUGAR COVE LN
CHAPEL HILL NC
27516-6320
US

IV. Provider business mailing address

242 MT EVANS DR
DURHAM NC
27705-2871
US

V. Phone/Fax

Practice location:
  • Phone: 910-912-5192
  • Fax: 910-401-1614
Mailing address:
  • Phone: 919-251-9001
  • Fax: 919-251-9008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC019480
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: