Healthcare Provider Details

I. General information

NPI: 1942110416
Provider Name (Legal Business Name): MAGGIE MIKAYLA COLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 S KERR AVE STE 200
WILMINGTON NC
28403-4248
US

IV. Provider business mailing address

108 SEA BREEZE CT
HAMPSTEAD NC
28443-2555
US

V. Phone/Fax

Practice location:
  • Phone: 910-788-2375
  • Fax:
Mailing address:
  • Phone: 910-617-5461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA23411
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: