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General NPI Number Information
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NPI Number | 1467848119
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Entity Type | Individual
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Provider Name | NEGAT NEGUSSIE-RETTA CRC, LPCA
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Gender | Female
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 04/09/2015
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Provider Practice Location Address
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Address Line | 106 W CHURCH ST SUITE H
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City | CREEDMOOR
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State | NC
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Zip | 27522-9766
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Country | US
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Telephone | 919-885-4046
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Fax | 919-477-1848
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Provider Business Mailing Address
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Address Line | PO BOX 73081
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City | DURHAM
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State | NC
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Zip | 27722-3081
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Country | US
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Telephone | 919-885-4046
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Fax | 919-477-1848
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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 | A11273
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License Number State | NC
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