Provider Demographics
NPI:1306522123
Name:MAXIME, SINGA
Entity type:Individual
Prefix:
First Name:SINGA
Middle Name:
Last Name:MAXIME
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 E ROMA AVE LOT 20
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-4198
Mailing Address - Country:US
Mailing Address - Phone:510-695-6321
Mailing Address - Fax:
Practice Address - Street 1:814 E ROMA AVE LOT 20
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-4198
Practice Address - Country:US
Practice Address - Phone:510-695-6321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health