Healthcare Provider Details

I. General information

NPI: 1134314628
Provider Name (Legal Business Name): PETALS CATRECE RAINEY MS, ED.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2007
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 ANNARON CT
RALEIGH NC
27603-3640
US

IV. Provider business mailing address

11321 INVOLUTE PL APT 103
RALEIGH NC
27617-8511
US

V. Phone/Fax

Practice location:
  • Phone: 919-307-8616
  • Fax:
Mailing address:
  • Phone: 919-961-1610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2318
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2318
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: