Healthcare Provider Details

I. General information

NPI: 1134059009
Provider Name (Legal Business Name): MARIA LAURA BERTACCHINI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 VANDORA SPRINGS RD
GARNER NC
27529-3543
US

IV. Provider business mailing address

4829 SALEM RIDGE RD
HOLLY SPRINGS NC
27540-9160
US

V. Phone/Fax

Practice location:
  • Phone: 919-283-3302
  • Fax:
Mailing address:
  • Phone: 919-819-4891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22938
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: