Provider Demographics
NPI:1992534689
Name:BURNETT, MAYA (RMHCI)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:BURNETT
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W PLYMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-2753
Mailing Address - Country:US
Mailing Address - Phone:386-873-2963
Mailing Address - Fax:386-873-2986
Practice Address - Street 1:3993 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-9726
Practice Address - Country:US
Practice Address - Phone:407-732-4272
Practice Address - Fax:407-732-4579
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25877101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health