Provider Demographics
NPI:1548626831
Name:RAKE, MAYA LYNTON (LISW-CP)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:LYNTON
Last Name:RAKE
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:MAYA
Other - Middle Name:LYNTON
Other - Last Name:ENGH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISW-CP
Mailing Address - Street 1:1415 BLANDING ST STE 4
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2922
Mailing Address - Country:US
Mailing Address - Phone:803-779-7500
Mailing Address - Fax:803-779-7522
Practice Address - Street 1:1415 BLANDING ST STE 4
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2922
Practice Address - Country:US
Practice Address - Phone:803-779-7500
Practice Address - Fax:803-779-7522
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-04
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10118101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health