Healthcare Provider Details

I. General information

NPI: 1235005612
Provider Name (Legal Business Name): MAGGIE NUNNALLY SAPP CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 PARK MEADOW CIR
WINSTON SALEM NC
27127-7496
US

IV. Provider business mailing address

1841 PARK MEADOW CIR
WINSTON SALEM NC
27127-7496
US

V. Phone/Fax

Practice location:
  • Phone: 252-908-3713
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCADC-13255
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: