Healthcare Provider Details

I. General information

NPI: 1255949251
Provider Name (Legal Business Name): AMBER MARIE PERRORAZIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13814 NC HIGHWAY 55
BAYBORO NC
28515-9108
US

IV. Provider business mailing address

216 GOLD LEAF DR
HAMPSTEAD NC
28443-3586
US

V. Phone/Fax

Practice location:
  • Phone: 770-778-5644
  • Fax:
Mailing address:
  • Phone: 770-778-5644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA15787
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA15787
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: