Provider Demographics
NPI:1427252774
Name:SOLOWAY, MAXINE NELLIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MAXINE
Middle Name:NELLIE
Last Name:SOLOWAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:NELLIE
Other - Middle Name:MAXINE
Other - Last Name:SOLOWAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:6905 FALCONBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517
Mailing Address - Country:US
Mailing Address - Phone:919-423-8649
Mailing Address - Fax:919-490-4845
Practice Address - Street 1:211 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514
Practice Address - Country:US
Practice Address - Phone:919-423-8649
Practice Address - Fax:919-490-4845
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC000077001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
78402OtherBCBS
05286600OtherMBC