Healthcare Provider Details

I. General information

NPI: 1164202974
Provider Name (Legal Business Name): SIMRAN VUPPALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 EXECUTIVE PL STE 202
FAYETTEVILLE NC
28305-5489
US

IV. Provider business mailing address

639 EXECUTIVE PL STE 202
FAYETTEVILLE NC
28305-5489
US

V. Phone/Fax

Practice location:
  • Phone: 910-319-8180
  • Fax:
Mailing address:
  • Phone: 910-319-8180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA19326
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: