Individual
JALISA MAYNARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1520 BEACON RIDGE CT, RALEIGH, NC 27610-8820
(919) 720-3819
Mailing address
1520 BEACON RIDGE CT APT 202, RALEIGH, NC 27610-8822
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
—
Other
Enumeration date
10/09/2024
Last updated
10/09/2024
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