Healthcare Provider Details

I. General information

NPI: 1861300477
Provider Name (Legal Business Name): RUDOLF H PETRINI LCMHC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4058 GUNSMITH CT
JAMESTOWN NC
27282-7787
US

IV. Provider business mailing address

4058 GUNSMITH CT
JAMESTOWN NC
27282-7787
US

V. Phone/Fax

Practice location:
  • Phone: 336-337-5679
  • Fax:
Mailing address:
  • Phone: 336-337-5679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. RUDOLF HARALD PETRINI
Title or Position: SOLE MEMBER
Credential: LCMHC
Phone: 336-337-5679