Provider Demographics
NPI:1972188159
Name:MAUNEY, CHARLES WESLEY
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:WESLEY
Last Name:MAUNEY
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:PO BOX 1004
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28359-1004
Mailing Address - Country:US
Mailing Address - Phone:910-844-2267
Mailing Address - Fax:910-401-1083
Practice Address - Street 1:109 W CENTRAL ST
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364-1703
Practice Address - Country:US
Practice Address - Phone:910-844-2267
Practice Address - Fax:910-401-1083
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0158061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1932304714Medicaid