Individual
MR. MAVERICK MCGOVERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPA
Contact information
Practice address
1252 LAKESHORE DR, NEW LONDON, NC 28127-6608
(336) 302-3444
(336) 302-3444
Mailing address
1252 LAKESHORE DR, NEW LONDON, NC 28127-6608
(336) 302-3444
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
0835
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6107459
—
NC
Enumeration date
10/31/2006
Last updated
06/06/2023
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