Provider Demographics
NPI:1154526259
Name:MCNALLY, MATTHEW WILLIAM (MA, LPA, CHSP-PA)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:WILLIAM
Last Name:MCNALLY
Suffix:
Gender:M
Credentials:MA, LPA, CHSP-PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 AVINSHIRE PL
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-5375
Mailing Address - Country:US
Mailing Address - Phone:919-880-4823
Mailing Address - Fax:
Practice Address - Street 1:2320 AVINSHIRE PL
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-5375
Practice Address - Country:US
Practice Address - Phone:919-556-7219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2107103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical