Healthcare Provider Details

I. General information

NPI: 1659210417
Provider Name (Legal Business Name): PATRICIA SOFIA ARCHILLA-FRATICELLI LCMHCA, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

B11 CALLE CRISANTEMOS
CAGUAS PR
00727-1259
US

IV. Provider business mailing address

1117 E MOREHEAD ST STE 200
CHARLOTTE NC
28204-2870
US

V. Phone/Fax

Practice location:
  • Phone: 939-273-4624
  • Fax:
Mailing address:
  • Phone: 980-220-2223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22244
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: