Healthcare Provider Details

I. General information

NPI: 1649570078
Provider Name (Legal Business Name): MISS RAKHEE PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 06/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 SHIPYARD BLVD
WILMINGTON NC
28412-6431
US

IV. Provider business mailing address

615 SHIPYARD BLVD
WILMINGTON NC
28412-6431
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-0145
  • Fax:
Mailing address:
  • Phone: 910-343-0145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2439
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4020
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: