Provider Demographics
NPI:1679155659
Name:MACIEROWSKI, AVERY EDWARD (LCMHCA)
Entity type:Individual
Prefix:MR
First Name:AVERY
Middle Name:EDWARD
Last Name:MACIEROWSKI
Suffix:
Gender:M
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2231
Mailing Address - Country:US
Mailing Address - Phone:919-205-5175
Mailing Address - Fax:919-214-9867
Practice Address - Street 1:201 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2231
Practice Address - Country:US
Practice Address - Phone:919-205-5175
Practice Address - Fax:919-214-9867
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15648101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health