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General NPI Number Information
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NPI Number | 1275309106
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Entity Type | Individual
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Provider Name | DEEPA MARY PANICKER LCMHC ASSOCIATE
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Gender | Female
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Dates
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Enumeration Date | 12/01/2023
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Last Update Date | 12/01/2023
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Provider Practice Location Address
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Address Line | 4351 MAIN ST STE 215
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City | HARRISBURG
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State | NC
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Zip | 28075-7429
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Country | US
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Telephone | 704-456-7078
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Fax | 980-216-8080
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Provider Business Mailing Address
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Address Line | 8306 BOURGESS CT
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City | INDIAN LAND
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State | SC
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Zip | 29707-8634
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Country | US
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Telephone | 704-241-2748
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | A19354
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License Number State | NC
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