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General NPI Number Information
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NPI Number | 1952932006
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Entity Type | Individual
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Provider Name | JUSTINE MAAS LCAS, CSI
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Gender | Female
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Dates
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Enumeration Date | 01/28/2020
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Last Update Date | 04/11/2023
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Provider Practice Location Address
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Address Line | 211 E SIX FORKS RD STE 117
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City | RALEIGH
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State | NC
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Zip | 27609-7753
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Country | US
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Telephone | 919-833-8894
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Fax |
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Provider Business Mailing Address
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Address Line | 817 LAKEMONT DR
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City | CLAYTON
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State | NC
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Zip | 27520-3070
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Country | US
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Telephone | 443-624-7565
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCAS-25799
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License Number State | NC
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