Provider Demographics
NPI:1679937668
Name:DEMOSS, MAGGIE (PHD)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:DEMOSS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 ZEPHYR CIR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-8803
Mailing Address - Country:US
Mailing Address - Phone:704-361-3701
Mailing Address - Fax:855-518-5592
Practice Address - Street 1:1007 ZEPHYR CIR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-8803
Practice Address - Country:US
Practice Address - Phone:704-361-3701
Practice Address - Fax:855-518-5592
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness