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General NPI Number Information
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NPI Number | 1245751866
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Entity Type | Individual
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Provider Name | DAVID MAYNARD CSW
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Gender | Male
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Dates
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Enumeration Date | 07/05/2017
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Last Update Date | 07/05/2017
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Provider Practice Location Address
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Address Line | 3701 LANDSDOWNE DR
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City | ASHLAND
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State | KY
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Zip | 41102-5422
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Country | US
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Telephone | 606-324-3005
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Fax | 606-329-1530
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Provider Business Mailing Address
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Address Line | PO BOX 790
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City | ASHLAND
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State | KY
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Zip | 41105-0790
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Country | US
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Telephone | 606-329-8588
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Fax | 606-329-8195
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 252587
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License Number State | KY
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