Healthcare Provider Details

I. General information

NPI: 1083109029
Provider Name (Legal Business Name): PERLA ROSANYI TALAVERA LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PERLA ROSANYI FRIAS LCMHC

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4106 SHIPYARD BLVD
WILMINGTON NC
28403-6155
US

IV. Provider business mailing address

4106 SHIPYARD BLVD
WILMINGTON NC
28403-6155
US

V. Phone/Fax

Practice location:
  • Phone: 910-769-1785
  • Fax: 910-769-3965
Mailing address:
  • Phone: 910-769-1785
  • Fax: 910-769-3965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17373
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: