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General NPI Number Information
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NPI Number | 1568180800
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Entity Type | Individual
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Provider Name | DAVID THOMAS MAXWELL LMFT-A
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Gender | Male
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Dates
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Enumeration Date | 08/22/2022
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 8392 SIX FORKS RD STE 202
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City | RALEIGH
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State | NC
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Zip | 27615-3061
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Country | US
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Telephone | 919-995-6998
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Fax |
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Provider Business Mailing Address
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Address Line | 257 MCDOWELL DR
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City | WAKE FOREST
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State | NC
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Zip | 27587-2571
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Country | US
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Telephone | 191-265-6307
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 12443A
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License Number State | NC
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