Healthcare Provider Details

I. General information

NPI: 1932295144
Provider Name (Legal Business Name): ANKUR BHAGAT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 BLUE RIDGE RD SUITE 200
RALEIGH NC
27612-4650
US

IV. Provider business mailing address

4000 BLUE RIDGE RD SUITE 200
RALEIGH NC
27612-4650
US

V. Phone/Fax

Practice location:
  • Phone: 919-782-4981
  • Fax: 919-782-2474
Mailing address:
  • Phone: 919-782-4981
  • Fax: 919-782-2474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCOO3843
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberCOO3843
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: