Provider Demographics
NPI:1699486241
Name:MACDONALD, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 OLD FORGE RD
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-9753
Mailing Address - Country:US
Mailing Address - Phone:919-805-2098
Mailing Address - Fax:
Practice Address - Street 1:418 OLD FORGE RD
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-9753
Practice Address - Country:US
Practice Address - Phone:919-805-2098
Practice Address - Fax:866-568-8043
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty